DMT Discontinuation in Older MS Patients: Clinical Outcomes Examined
Most older adults (>60 years) with multiple sclerosis (MS) who discontinued disease-modifying therapies (DMT), remained off DMT, according to a study published in Multiple Sclerosis Journal.
To better understand the risk-benefit profile of continuing DMT in older adults with MS, researchers conducted a retrospective, observational study to assess clinical and patient-reported outcomes after treatment discontinuation. They included 600 MS patients aged ≥60 years who received DMT for over 2 years and compared Performance Scales (PS), Timed 25-Foot Walk, and Patient Health Questionnaire-9 (PHQ9) pre- and post-discontinuation.
On average, patients were exposed to 2 DMTs during their course of treatment; the agents used were similar between discontinuers and continuers. Most patients (90.5%) were treated with interferon at one point during their disease; glatiramer acetate was also commonly prescribed (42.2%).
Of the total patients, 178 (29.7%) discontinued DMT during the study period with only 1 documented relapse occurring in the discontinuers. Side effects, stable disease, age, lack of benefit, secondary progressive disease, comorbidities, and cost were cited as the most common reasons for discontinuation.
Approximately 10% of these patients restarted DMT due to patient preference, MRI changes, clinical progression, provider preference, or clinical trial participation. The results also showed that providers initiated treatment discontinuation more often than patients (68.0%). Provider-initiated discontinuers were less likely to restart DMT compared to patients who requested discontinuation (hazard ratio [HR] 0.34, 95% CI: 0.12-0.9).
A lower average PS was observed among relapsing-remitting MS discontinuers vs primary progressive MS patients. Also, compared with patient-initiated discontinuers, the provider-initiated discontinuers had a lower PS. PHQ9 scores were higher among those discontinuing intravenous (IV) therapies vs interferon therapies.
"Prior discontinuation studies have focused on DMT discontinuation in younger stable patients with mixed results," the authors write. "By focusing on stopping DMT in older patients with MS, we show that DMT discontinuation is more successful when age is considered, compared to disease stability alone, as this can help serve as a surrogate for “burnt out” inflammatory processes and aging immune systems."
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