Researchers Compare Outcomes When People 50 and Over Continue or Stop Their MS Therapies

Researchers consulted medical records from the French MS Registry to observe disease activity outcomes in people with MS who were 50 or older who had stopped taking highly effective* disease modifying therapies (DMTs) compared to matched individuals who continued on their highly effective therapies. They found that those on two particular therapies were more likely to experience new relapses after stopping. Read below for more details.

*In this study, the highly effective therapies studied were natalizumab, fingolimod, and anti-CD20 therapies (ocrelizumab and rituximab).
DETAILS
Background: Getting and staying on an MS disease-modifying therapy is the best way to reduce the chances of future inflammation and disease activity. But when is it safe to stop taking MS therapies, especially in older age when MS tends to be less inflammatory?
One previous clinical trial asked this question in people who were 55 or older and largely taking first-generation therapies such as interferon beta or glatiramer acetate and found that discontinuing might be an option for some. Questions remain about when and how it is safer to stop taking disease-modifying therapies in people who are older and whose MS is not active, and especially people taking second-generation, high efficacy therapies.
For this study using the French MS Registry, researchers identified 1620 people with non-active MS (in this case people who had no relapses or MRI activity in two years or more) to include. They then matched and compared 154 of them who had discontinued their therapy with 154 who had continued therapy. The researchers then observed via their medical records what happened in terms of their MS disease activity over about two years.
Results:

• Overall, the people who had discontinued their highly effective therapies were more likely to experience an MS relapse and progression compared to those who continued on therapy, and many later resumed therapy.
• Those who had discontinued taking natalizumab or fingolimod were much more likely to experience relapses within one year compared to those who discontinued taking anti-CD20 therapies. The authors noted that both natalizumab and fingolimod work by keeping immune cells from entering the central nervous system, so discontinuing may have opened the gates and caused a rebound of MS activity.
• The authors also commented that additional follow-up time beyond two years may have provided more information about disease activity in those who had discontinued anti-CD20 therapies.

Why does this matter? Studies like this one provide critical information about when it's safe to stop taking MS disease-modifying therapies. Having the answer will decrease unnecessary exposure to potential side effects and lower the cost of healthcare.
Learn more about treating MS "High-Efficacy Therapy Discontinuation vs Continuation in Patients 50 Years and Older With Nonactive MS," by Guillaume Jouvenot, MSc, Guilhem Courbon, MD, Mathilde Lefort, PhD, Anne Kerbrat, MD, PhD, and others for the OFSEP Investigators, was published early online on March 25, 2024 in JAMA Neurology.

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