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

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by Diogo Pinto |

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Disease-modifying therapies

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.

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