#CMSC17 – Review Suggests Certain MS Patient Groups May Discontinue Disease-Modifying Treatments

#CMSC17 – Review Suggests Certain MS Patient Groups May Discontinue Disease-Modifying Treatments

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.

7 comments

  1. Doris Backstrom says:

    Am 77. Diagnosed in 2003. Have used Lyrica and Copazone, 40 mg 3 times a week , for 10 years. MRI taken May 30
    and ten years between last MRI show brain is “stable. “.

    I have improved since 2006 with walking every day. Not far. Do not use a cane or walker. Move slowly.

    Thought my case might be interesting.

  2. MB says:

    Never started DMDs so no need to be concerned with stopping. Treatments that are worse than the diseases they treat aren’t for me.

    • George says:

      I am 67, my symptoms began in 1978, diagnosis made in 1989, I went on the first ever FDA-approved drug for RRMS. I immediately got MUCH WORSE. No one wanted to hear that. Yours is the first similar result I’ve read. LTD since ’93. Bed-ridden now….sigh

  3. DeAnna says:

    It is very uncommon to find a neurologist that supports HSCT as a treatment for autoimmune neurological disorders (such as MS and CIDP, etc.). Neurologists know a whole lot about nerves but usually know quite little about the actual underlying pathogenesis of autoimmune diseases which reside in the immune system. Because neurologists are typically not educated, not trained and not experienced in HSCT and why it is the most effective medical intervention so far discovered for hematologically-rooted autoimmune disorders, it is human nature that someone ignorant on the subject will not support something they don’t understand. I like to use the analogy that you wouldn’t choose a house painter to fix your car engine because it is a complete mismatch of skills, so why would you choose a neurologist to consult about your immune system? (A hematologist is the right specialty.) For treatment of these disease types, seems like the only skill most neurologists have is to prescribe a lifetime of drugs that have no hope of halting the underlying autoimmune disease the way HSCT can.

    • Rhonda Danielson says:

      DeAnna,

      Wow! This is a mind bending, paradigm altering thought you have here. I love your analogy.

      Are you pursuing this with your docs and the greater medical MS community?

      If you are not, you should.

      I know I will be with my new neuro when I see him in October.

  4. Donna Mcfarland says:

    Wellll, isnt this interesting eh?! Since diagnosed in 1989 & being given a virtual early death sentance, I began seeing Dr. Roy Laver Swank..the true HERO of neurology as professor of neuro. at the Oregon Health & Sciences University. He literally-saved my life! On his diet/rest/stress reduction program since then. 28 years! No drugs ever. No need to see any neuro’s again either. So much for the “MS specialist’s” prognosis!

  5. Greg says:

    I am stupid as one gets. So would I be booted off? Age 55 last month.. Went from Copaxone to GLATOPA and first time in 5 yeas. I had brain and neck lesion..progress. I am borderline R&R. All day long – pain. But it goes away with meds. In last 6 mos 6 good MS free (a stretch). Days. I had energy. Social Security. Is reviews mg my case to take me off…. Two docs and 36 mris say I am unfit to work. I wld love to work. But off track. Is this definite? I don’t want to walkna drig free tightrope. Copaxone had me stable until I changed to generic brand

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