Discontinuing Multiple Sclerosis Therapies at Age 55 or Older

An article published in the journal Lancet Neurology evaluates the risk of recurrence of active disease in older patients with multiple sclerosis after discontinuing disease-modifying therapies.

Thus, benefits in older patients remain unclear, while risks related to the DMTs may increase with age. Whether it is reasonable to stop using the DMTs as people age remains an important, unanswered question.

The article reports the results of a clinical trial known as DISCOMS, the first randomized, controlled, observer-blinded trial of discontinuation of MS DMTs. Between May 2017 and February 2020, researchers recruited 259 participants over 55 who had not had an acute MS relapse for at least five years and no new MRI lesion for at least three years from 19 MS centers in the United States. Using any new relapse or MRI scan change over two years as the main outcome, the study asked whether it was non-inferior to discontinue compared to staying on DMT.

Only 22/259 (6/128 in the continue group and 16/131 in the discontinue group) total individuals had a new event (relapse or MRI scan change). 

By this measure, the researchers were unable to show non-inferiority, i.e. it could be inferior to stop DMT, noting that 15/22 of the new events were 1-2 new MRI lesions unaccompanied by any relapse or change in disability, and only four (one continue, three discontinue) participants had an acute relapse.

There also was no increase in disability, symptom scores, cognitive tests, or adverse events in those discontinuing DMT.