Should You Stop Your MS Treatment?
Well established predictors of relapses or new MRI lesions after stopping DMT’s in stable patients are younger age, less disability and previously “active” MS. But the average age of MS patients has shifted from 20–40 years to 50’s, 60’s and older, as people with MS live longer given new and more effective therapies.
A common scenario is a patient on treatment and stable for 10–20 years. DMT use in an aging MS population is complicated by financial burdens, risks of infections, and especially the fact that relapse rate falls dramatically with age. Is increasing disability with age caused by disease progression, ageing, deconditioning, or co-morbidities? For most patients, this is hard to know.
A new study, titled “Discontinuation of disease modifying therapies (DMT’s) is associated with disability progression regardless of prior stable disease and age,” addressed this question.
These were the findings:
1. 1 in 3 previously stable patients who stopped their DMT had worsening disability without relapses.
2. Age alone was not a factor in this risk.
3. Patients with secondary progressive MS who required walking assistance (cane or walker) were at greater risk than those with lower levels of disability.
The takeaway is that previous disease stability and older age are not reliable predictors of continued stability after DMT discontinuation.
Tread carefully here.
The article is by Jakimovski et al in Multiple Sclerosis and Related Disorders, 2022.
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