ECTRIMS 2025: Some older adults with MS may safely stop DMTs
But patients older than 60 must still be monitored for new disease activity
Some older people with multiple sclerosis (MS), namely those older than 60, may be able to safely discontinue disease-modifying therapies (DMTs) as long as they continue to be regularly monitored for new disease activity, a new study suggests.
The findings showed that people older than 50 generally experience an increase in inflammatory activity seen on MRI scans after treatment discontinuation, but that did not translate to more relapses. Still, people ages 60 and older were at the lowest risk of new inflammation after discontinuation.
René Carvajal, MD, a neurologist and researcher at the Multiple Sclerosis Centre of Catalonia, discussed the data at the 41st Congress of the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS), being held Sept. 24 to 26 in Barcelona, Spain. Carvajal’s presentation was titled “Defining Optimal Profiles for Treatment Discontinuation in Older MS Patients.”
According to Carvajal, now a PhD candidate at the University of Vic-Central University of Catalonia, these findings support a “cautious approach to DMT discontinuation in carefully selected patients older than 50 years, appearing safer in those beyond 60 years of age with systematic MRI monitoring.”
While MS has a typical onset in early or middle adulthood, advances in care mean that patients are now living longer after their diagnosis. Data show that more than half of people living with the neurodegenerative disease are 50 or older. This brings new considerations for MS care.
Treatment discontinuation strategies now ‘an important focus’ of research
Most available DMTs — there are more than a dozen widely approved — target the localized inflammatory activity in the brain and spinal cord that drives symptom flares in relapsing forms of MS.
However, older people have less of this inflammation and are instead more likely to show continuous disease progression and disability accumulation even in the absence of relapses. Thus, available DMTs may not be as effective in this population.
In addition, older MS patients are more likely to experience side effects from DMTs. The rate of infections, a known risk of the immune-suppressing medications used to treat MS, “increases exponentially after the age of 60,” according to Carvajal.
“That’s why treatment discontinuation or de-escalation strategies … have become an important focus of current research,” the scientist noted. However, there’s a need for research to establish which patients may be eligible to stop treatment safely.
[The rate of infections, a known risk of immune-suppressing medications,] increases exponentially after the age of 60.
In conducting this analysis, the research team aimed to learn more about treatment discontinuation in older people with MS. To that end, the scientists examined data from MS patients ages 50 and older who were seen at their center in Spain and who received DMTs for at least six months between 1994 and 2024.
Of the 563 patients studied, 113 (20%) stopped treatment without restarting for at least six months. The remaining individuals who did not stop treatment were included as a control group.
Those in the discontinuation group stopped treatment at a median age of 58, after having been free of signs of focal inflammation — any localized area of inflammation — for a median of 4.5 years. Tolerability issues were the main reason for discontinuation.
Over a median follow-up of about five years, the group who stopped using DMTs experienced an inflammatory activity event, defined as a clinical relapse or MRI disease activity, earlier than the control group. Rates of inflammatory activity, particularly MRI activity, also increased after treatment discontinuation.
There were no overall differences between the groups, however, in terms of relapse rates, disability progression, or survival, the data showed.
No clinical relapses occurred in small number of patients stopping DMTs
The increase in inflammatory activity after discontinuation was most pronounced in people who had been treated with antitrafficking therapies, which include Tysabri (natalizumab), Mayzent (siponimod), Ponvory (ponesimod), Zeposia (ozanimod), and Gilenya (fingolimod).
While no person who continued these treatments experienced new inflammatory activity, 60% of those who stopped them did. Carvajal said that such data suggest that antitrafficking therapies “should not be withdrawn without a clear exit strategy.”
The lowest risk of new inflammation was seen after discontinuing anti-CD20 treatments, which include Ocrevus (ocrelizumab), Kesimpta (ofatumumab), and Briumvi (ublituximab).
While rates of inflammatory activity over the follow-up period were significantly higher in people who discontinued anti-CD20 therapies than in those who stayed on them, these rates were low in both groups (8.7% vs. 1.7%). Importantly, no clinical relapses happened in any of the groups.
Additional analyses indicated that people older than 60 had a significantly lower risk of inflammatory activity than those ages 50-60. Consistently, those patients were also 93% less likely to resume treatment compared with those ages 50-55.
While the findings overall suggest that some older individuals with MS, especially those older than 60, can safely stop treatment, Carvajal emphasized that this study included relatively small numbers of patients in certain treatment groups. As such, “larger studies …. will be required,” the scientist concluded.
Note: The Multiple Sclerosis News Today team is providing live coverage of the 41st Congress of the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) Sept. 24-26. Go here to see the latest stories from the conference.
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