Two Factors Lead to Better Outcomes when Disease-modifying Therapies Stopped, Study Finds

Two Factors Lead to Better Outcomes when Disease-modifying Therapies Stopped, Study Finds

A lot of people with multiple sclerosis take disease-modifying therapies to reduce the inflammation associated with the disease — but in many patients, the treatments’ effectiveness wanes at a certain points.

When that occurs, the question is whether to stop taking these treatments, known as DMTs. A study reports that patients’ outcomes are better if they discontinue the treatments when they are over 60 years of age and when their doctors advise them to stop.

The research, “Discontinuation of disease-modifying therapy in patients with multiple sclerosis over age 60,” appeared in the Multiple Sclerosis Journal.

By targeting the immune system, DMTs decrease inflammatory activity. But over time, inflammation decreases on its own. Some patients start to accumulate disabilities gradually, regardless of relapses and with no apparent inflammatory activity.

Researchers believe that at this point the inflammation caused by MS ceases and other mechanisms drive the disease’s progression. This raises the question of whether to continue taking DMTs.

A patient’s age and their doctor’s advice should be considered when making this decision, researchers said.

Studies have shown that both the frequency of relapses and the immune system’s  functioning decrease with age. In addition, treatment patterns vary. A key reason is that there are no guidelines that doctors can use when treating patients over 60 with DMTs.

Researchers decided to look at DMT discontinuation rates in patients over 60. The research included comparing physician- and patient-reported outcomes in those who stopped the treatment.

Thirty percent or 178 of the 600 patients in the study stopping taking DMTs. Those who discontinued treatment were 2.2 years older than the others. They also had MS 3.2 years longer but had been treated 1.6 years less.

Researchers used two outcome measures — patients’ scores on performance scales (PS) and patient health questionnaire-9 (PHQ9). Lower PS and PHQ9 indicate better outcomes.

Doctors were the driving force behind 68 percent of the treatment discontinuation cases.

Among those who stopped treatment, relapsing-remitting MS patients had lower PS than primary progressive patients. Also, physician-initiated discontinuation was linked to lower PS than patient-initiated discontinuation.

PHQ9 scores appeared to be higher in patients who discontinued intravenous DMTs, including Tysabri (natalizumab) and Novantrone (mitoxantrone), compared with those treated with interferons.

After stopping treatment, 10.7 percent of the patients went back on DMTs.

Researchers found DMT discontinuation more successful when a patient’s age, and not just disease stability, was taken into account. They also discovered that patients who stopped taking DMTs on their doctor’s advice fared better than those who stopped on their own.

“Most patients over age 60, who discontinued DMT, remained off DMT,” the researchers wrote. “We hope that these results drive the discussion toward understanding the changes occurring with age in MS patients.”

“This study can also offer some reassurance when considering DMT discontinuation in older MS patients,” the team concluded.

5 comments

  1. Desiree Z says:

    I recently had to stop Tysabri, at the advice of both my infectious disease doctor as well as my Neuro..i had developed Lyme disease. I had no rash. it was undiagnosed for six months. I am 60 and s half and still fairly mobile. I have had MS FOR 44 YEARS. I feel great now…still work.

  2. Steve Simon says:

    So now we’re subjects of studies relying strictly on anecdotal evidence combined with age discrimination? I now demand funding for my study. A simple 5 million dollars will be enough to see if researchers of this quality would be more appropriately assigned to flipping burgers at a fast food establishment until they successfully pass puberty.

  3. Elizabeth says:

    please advise about secondary progressive ms. does everyone get spms. why don’t we ever hear about treatments!!!

  4. itasara says:

    My daughter was on Avonex from about age 20 until about age 33. She was extremely well physically and apparently her MRI’s looked good. I have no details as she didn’t discuss it with me and I don’t know her neurologist who told her to have an MRI every 6 months and to come off her DMT. She says she is “cured.” She is 35 this year.
    Meanwhile I am 70 and have been on Copaxone since 2006 (dx in 2005.) I had no MRI’s since 2007 until last week. Physically I am okay and had no active lesions in 2005 have no active lesions in 2018 but maybe more lesions than I did in 2007 and more scarring. Before this last MRI, I had asked if I could also come off my DMT considering my age. Before this last MRI, and my neurologist didn’t think I should. Now he wants me to see an MS specialist, for a 2nd opinion perhaps to change meds, which I am not sure I want to do.
    Like everything else with MS there are no definite answers, are there? Is there in our case any for sure known reason to stay on or come off DMTs. How much of a risk is it to change DMTs or to stay on DMTs or not when one’s age is 70 or in 35 or more?

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