MS relapses rare after age 60 whether DMTs continued or stopped

People with multiple sclerosis (MS) who were older than 60 had a low risk of disease flares whether they continued or stopped taking disease-modifying therapies (DMTs), according to a recent study.

According to researchers, these data suggest that some older adults with MS may be able to consider discontinuing DMTs without having a higher risk of disease flares than those who continue treatment. The scientists noted, however, that while flares were rare, new signs of disease activity on MRI scans were common, and they stressed a need for further studies to understand the implications of these imaging findings.

“The optimal approach to MS treatment among older adults will likely remain a topic of discussion for the foreseeable future, though our long-term follow-up study demonstrates the feasibility of DMT discontinuation after age 60,” the researchers wrote. “We demonstrated a low clinical relapse risk among this patient population, though radiological changes were more common than expected. As the average age of individuals living with MS increases, ongoing investigations into DMT risk-benefit optimization in older adults will be essential.”

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Study focused on older adults with MS

The study, “Long-term follow-up of patients with multiple sclerosis over age 60: Comparing clinical and radiological outcomes in disease-modifying therapy continuers and discontinuers,” was published in Multiple Sclerosis Journal – Experimental, Translational and Clinical.

MS is a chronic neurological disorder characterized by inflammation in the brain and spinal cord. In most people with MS, the disease is marked by flares or relapses, which are periods when symptoms suddenly worsen or new ones appear.

MS flares can lead to long-term disability, so preventing flares is a major goal of MS treatment. Generally, this is accomplished using DMTs, medications that can reduce relapses and other signs of inflammatory disease activity. Some also may help slow disability worsening.

Previous studies have shown that MS flares generally become less common as patients get older, particularly past age 60. At the same time, DMTs can increase the risk of health problems like infections, which are generally more of a concern in older adults. As such, some scientists have suggested that the risks of DMTs in older MS patients may outweigh the benefits, but there isn’t much published data directly addressing this issue.

To learn more, scientists analyzed outcomes from 600 MS patients older than 60 who received care at Cleveland Clinic MS centers between 2010 and 2016. All had been diagnosed before age 60 and had previously been on a DMT, most commonly interferons or glatiramer acetate (sold as Copaxone and generics).

Of the 600 people in the study, 204 continued taking DMTs, while the remaining 396 discontinued DMTs. Those who discontinued usually did so in their mid-60s.

Relapses were uncommon after age 60

Most patients in the study were followed for a median of 10.5 years. Over the entire follow-up, only 3.3% of patients experienced any relapses after age 60. Most of these patients had a single recorded flare; of the 600 patients in the study, only two individuals had more than one relapse past age 60. Statistical analyses showed that the risk of relapse was not significantly different between patients who continued DMTs and those who discontinued.

“Our study evaluated [MS patients older than] 60 and demonstrated few significant differences between DMT continuers and discontinuers. Clinical relapse risk was low in both groups,” the researchers wrote.

Rates of new lesions, or areas of damage, visible on MRI scans were also similar among patients who continued or discontinued DMTs. However, among those with available MRI data, rates of new MRI activity were higher than expected, with roughly a third of patients showing new T2 lesions. The clinical implications of these imaging findings aren’t clear, according to researchers.

“Additional studies with consistent follow-up are needed to better understand the causes and frequency of MRI changes among this population,” the scientists said.

Among patient-reported quality-of-life measures, the only statistically significant difference observed between the DMT continuers and discontinuers concerned fatigue severity. In patients who continued DMTs, fatigue tended to ease over time. By contrast, patients who discontinued DMTs tended to have worsening fatigue over time, both before and after stopping treatment. Since DMTs have generally not been shown to have much effect on MS fatigue, the researchers said it’s unlikely the difference in fatigue scores was due to DMT use, noting that other factors may have contributed to these differences.