Older age at disease-modifying therapy (DMT) discontinuation is the main predictive factor of sustained “no evidence of disease activity” (NEDA) in people starting DMT immediately after being diagnosed with clinically isolated syndrome (CIS), according to a study in Austria.
In particular, patients discontinuing DMT at age 45 or older after at least five years of NEDA showed a significantly lower risk of disease reappearance than those stopping therapy before that age.
These findings may help inform treatment decisions after sustained NEDA in this patient population and suggest that DMT discontinuation with continuous monitoring may be a low-risk option for patients older than 45.
The study, “Should I stop or should I go on? Disease modifying therapy after the first clinical episode of multiple sclerosis,” was published in the Journal of Neurology.
CIS, a neurologic episode that lasts at least 24 hours, often is the first clinical presentation of multiple sclerosis (MS). Several DMTs have been approved for relapsing forms of MS, including CIS.
Notably, interferon-beta products, such as Rebif (by EMD Serono, known as Merck KGaA outside North America.), and glatiramer acetate (marketed as Copaxone by Teva Pharmaceuticals, or Glatopa, its generic form by Sandoz) were shown to significantly delay the conversion from CIS to clinically definite MS in clinical trials. Both types of therapies are available in injectable forms.
A proportion of CIS patients may achieve NEDA — a status defined by the absence of new or enlarging brain lesions, relapses, and confirmed disability progression — after DMTs and remain free of disease activity for prolonged periods.
This may prompt “consideration of DMT discontinuation in CIS patients and treating neurologists, especially if patients experience adverse events or [needle] fatigue,” the researchers wrote, noting that convenience and economic burden also may drive the discussion on whether to continue treatment. (Needle fatigue represents a waning commitment to continue with the prescribed injectable treatment.)
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