Older patients with secondary progressive multiple sclerosis (SPMS) as well as older relapsing patients whose MS has been inactive after five years may safely discontinue their treatments, Canadian researchers at Vancouver’s University of British Columbia argue.
Their Sanofi Genzyme-sponsored study, “When Should Disease-Modifying Treatments Be Discontinued in Patients with Multiple Sclerosis: An Evidence-Based Review with Expert Recommendations,” was presented at the May 24-27 Consortium of Multiple Sclerosis Centers (CMSC) 2017 Annual Meeting in New Orleans. It adds to an ongoing debate on whether disease-modifying drugs do any good in later MS disease stages.
It’s a topic of discussion mainly because little actual data exists on the use of such drugs in older patients or in later disease stages. Clinical trials of these therapies rarely include patients who are late in their relapsing MS course, as well as secondary progressive or older patients. Furthermore, physicians and researchers believe that while disease-modifying drugs don’t really help such patients, they can still cause side effects, some of them potentially life-threatening.
Attempt to gather information, UBC researchers reviewed all studies of disease-modifying treatment withdrawals published up to June 2016. The data showed that disease activity in MS declines as patients age, but also becomes lower with longer disease duration. Several of the reviewed observational studies suggested that older patients who are disease-free for several years while on treatments,
Although the team concurred that the preference of individual patients is an important consideration, they argued that discontinuation of disease-modifying treatment is a reasonable consideration in some patient groups.
So are SMPS patients aged 55 years or older who show progressive disability without relapses or new brain lesions in the last five years may be good candidates for discontinuing those drugs. So are older relapsing MS patients who have not had relapses or disease activity on magnetic resonance imaging (MRI) in five years.
The team did say, however, that it is crucial to continue monitoring patients after stopping a treatment. Safety monitoring, they argue, must include an annual clinical assessment and yearly brain MRIs for two to five years. Should patients show evidence of disease activity in the form of a relapse of more than two new brain lesion, physicians should consider resuming disease-modifying treatments.