Should MS Patients Stop Treatment as They Age?

Derick Alison
Derick Alison
3 Min Read

Stopping multiple sclerosis (MS) treatment as patients age can be a difficult decision, but there are considerations that may help with that process.

In this exclusive video, Enrique Alvarez, MD, PhD, from the University of Colorado Denver School of Medicine, offered perspective on data from the DISCOMS study that was recently published in Lancet Neurology, and addressed some of the challenges when deciding whether patients with MS should discontinue disease-modifying therapy (DMT) as they get older.

Following is a transcript of his remarks:

I think the challenge is just having a good conversation with the patient, right? I think that’s the biggest challenge, because I think sometimes patients feel like you’re abandoning them, though, when you’re having that discussion about stopping treatment. And it’s more about like, no, this is the part where now we have to really start paying attention because you’ve been doing well and we got to keep doing MRIs and follow you clinically. So no, you’re still part of our clinic and we’re still going to take care of you. And that becomes really important psychologically with the patient.

And so at ECTRIMS, there was also the extension to DISCOMS, and they also had … there were no relapses in about a third … there were 70 some patients that entered that extension study. And there was one patient with an MRI lesion in the continue treatment, two in the discontinue. So again, it’ll be not non-inferior in that regard.

But I think, yeah, the length of time becomes important. We tried to look at this last year in one of our presentations at ECTRIMS, and it got really messy from a data perspective, because when you start looking at relapses in older patients, the reason we take these out is there’s concern for other pathologies leading to symptoms coming up or pseudo-relapses. And the longer disease duration, especially in the high-efficacy therapies, was associated with more events. And if we concentrated just on looking at MRI data, then we saw that it actually leveled off and we didn’t see an increased level of disease activity in them.

So, I think these comorbid conditions — and recognizing that just because you have MS doesn’t mean you can’t have other things — becomes really important as well. So yeah, we’ll see how the field expands in this area.

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    Greg Laub is the Senior Director of Video and currently leads the video and podcast production teams. Follow

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