Study Suggests Older Adults with MS May Consider Stopping their MS Therapy in Consultation with an MS Neurologist
June 27, 2023
Among 259 adults with MS over age 55, there was no significant difference in the number of participants who had a relapse or new disease activity on MRI scans, whether
disease-modifying therapy (DMT) was continued or discontinued over the course of two years. Most of the participants were on first-generation therapies such as interferon beta or glatiramer acetate. Therefore, these findings are applicable to individuals on those types of treatments. These findings highlight the importance of shared decision-making between people living with MS and their providers – please see below for resources for having these conversations with providers.
- Background: DMTs are designed to dampen immune system activity and reduce the number of new relapses and MRI-detected lesions, and may reduce the accumulation of disability. There are currently no clear ways to determine at what point a therapy can be safely discontinued later in life. John Corboy, MD (University of Colorado, Denver) and colleagues sought to determine if and when DMTs should be discontinued in older adults, in a project funded by the Patient-Centered Outcomes Research Institute (PCORI) with co-funding from the National MS Society.
- This Study: The investigators enrolled 259 people with MS across the United States, who were randomly assigned to continue or discontinue their DMTs. Participants were 55 years or older, had no MS relapses in the past five years, or had no new disease activity detected on MRI scans in the past three years. They were followed for two years. Among both groups, most participants (73%) were taking injectable drugs (glatiramer acetate or interferon beta). The primary goal of the study was to determine differences between the groups in the percentage of people with a “new disease event” – meaning, a relapse or new lesion activity on MRI scans.
- Results: The results showed that a relapse or new activity on MRI scans occurred in about 5% of those who continued treatment and in 12% of those who discontinued treatment. These differences were not statistically significant – meaning that they do not prove or disprove that continuing treatment is more beneficial than discontinuing treatment. The number of people with adverse events, mostly upper respiratory infections, did not differ significantly between groups. Since most participants were on first-generation injectable therapies, there is not enough evidence to apply these findings individuals on more highly effective therapies.
- What does this mean? This study provides important data to inform the decision about whether and when to discontinue disease-modifying treatment for MS. Questions remain, such as would the results differ with longer follow-up? Would they be different if participants were primarily taking higher efficacy therapies and these therapies were reduced gradually or switched to lower efficacy therapies?
Further studies will help to answer these questions, and also to address how to handle relapses that occur if therapy is discontinued. For now, these findings show that the decision to continue or discontinue treatment in later life remains an important conversation between people affected by MS and their providers, where shared decision-making is key. Please see below for resources that can help you to have this conversation.
Learn more
“
Risk of new disease activity in patients with multiple sclerosis who continue or discontinue disease-modifying therapies (DISCOMS): a multicentre, randomised, single-blind, phase 4, non-inferiority trial” by John R Corboy, Robert J Fox, Ilya Kister, Gary R Cutter, Charity J Morgan, Rebecca Seale, Eric Engebretson, Tarah Gustafson, and Aaron E Miller, on behalf of the DISCOMS investigators, is published in
The Lancet Neurology 2023;22(7):568-577.