Drug discontinuation

Older people with multiple sclerosis (MS) who have not experienced disease activity for several years still will benefit from disease-modifying therapies (DMTs) to control the neurodegenerative disorder, a new study found. Data from a first trial assessing whether discontinuation of DMTs among these patients is at least as…

People over 60 with multiple sclerosis (MS) who have stable disease may discontinue their disease-modifying treatments (DMTs) without an added risk of relapses or worsening disability, according to a small study. At that age, only the presence of lesions with active inflammation and an Expanded Disability…

About 10%-20% of people with multiple sclerosis (MS) receive baclofen to control their spasticity, but up to half of patients stop the medication in the first six months, a large Swedish population-based study shows. The high rates of discontinuation suggest baclofen has “a low success rate of…

Tecfidera has a lower risk of discontinuation due to treatment failure than Aubagio in people with multiple sclerosis (MS), a new observational study in Norway suggests. In the study, people receiving Tecfidera (dimethyl fumarate) were 38% less likely to experience treatment failure and stop use than those receiving…

Rituximab shows long-term benefits, even among people with relapsing-remitting multiple sclerosis (RRMS) and clinically isolated syndrome (CIS) who stopped its use or reduced their dose, a study reported. Researchers found little evidence of disease reactivation among patients who discontinued the medication, and an adequate inflammatory disease suppression…

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…

The likelihood of discontinuing treatment with Tysabri (natalizumab) is higher among patients with progressive relapsing multiple sclerosis, and those who smoke and are depressed, a study reported. Progressive relapsing MS (PRMS) is now largely considered a subset of primary progressive MS, or PPMS marked by periods…

A twice-daily dosing schedule and side effects like nausea and flushing are key reasons why more than 10% of multiple sclerosis (MS) patients followed for a year stopped using Tecfidera (dimethyl fumarate) as prescribed, a single-site study reports. Adherence to treatment is key to patients’ health, and doctors should not…

Multiple sclerosis (MS) patients in Canada are more likely to comply with their treatment plan and less likely to discontinue the use of the oral disease-modifying treatment Gilenya (fingolimod), compared to injectable or infusible treatment options, new research shows. The research article with that finding, “A…

If you are being treated with Gilenya, take note. The U.S. Food and Drug Administration is warning that if you stop using Gilenya (fingolimod), there’s a chance your MS could become worse. The FDA issued a safety alert saying that this only happens rarely, but when it does, the…

The U.S. Food and Drug Administration (FDA) has issued a safety alert, warning that people with relapsing multiple sclerosis (MS) who stop using Gilenya (fingolimod) may experience disease worsening beyond that when starting the medicine or while taking it. Reported cases of such increases in MS disability upon stopping treatment are…

I’m not taking all the medication I’ve been prescribed. Chances are, you’re not either. Medication nonadherence, or not taking medicine as prescribed, is a thing — a big thing. According to a column in The New York Times,…

Discontinuing Gilenya (fingolimod) treatment and starting on rituximab therapy may be more complicated than originally thought. A new report chronicles the medical journey of a man with multiple sclerosis (MS) treated with these drugs, and proposes a new treatment regimen. Both Gilenya (an approved MS therapy marketed by…

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’…

Biogen and AbbVie have voluntarily withdrawn global marketing authorizations for their relapsing multiple sclerosis therapy Zinbryta (daclizumab) because of serious side effects that include brain inflammation. The Europe Medicine Agency, which oversees medications across the European Union, also released a statement recommending a “immediate suspension” of Zinbryta’s use by patients and…

Multiple sclerosis patients with high relapse rates but less physical impairment before starting on  Novartis’ Gilenya (fingolimod) are likely to experience a surge in disease activity if they stop the treatment, researchers in Turkey report. The study, which dealt with patients with relapsing forms of MS, referred to the surge as "severe disease reactivation," or SDR. Researchers published their article, “Factors Predictive of Severe Multiple Sclerosis Disease Reactivation After Fingolimod Cessation,” in the journal The Neurologist. Studies have shown that Gilenya, which the U.S. Food and Drug Administration approved in 2010, can benefit adults with relapsing MS. It reduces annualized relapse rates and prevents more brain lesions from forming, compared with standard interferon treatments. Lesions are damaged nerve cell areas. Despite its benefits, Gilenya is not recommended for patients with heart or liver problems, low levels of white blood cells, severe herpes virus infections or other infections. Also, patients who do not respond to Gilenya and women who are planning to become pregnant are advised to stop the treatment. Discontinuing Gilenya can lead to a return to pretreatment disease activity, or severe disease reactivation, in some patients. It is unclear why this happens and why it affects only some patients. To better understand what risk factors could be associated with reactivation, a team at Istanbul University compared the demographic and disease features of patients who developed SDR after stopping treatment with Gilenya. SDR was defined as including these elements within 6 months of Gilenya discontinuation: more than 5 gadolinium-enhanced lesions or a tumefactive demyelinating lesion detectable by magnetic resonance imaging, the disease progressing to the point that additional treatment with methylprednisolone or plasma exchange was required, and progressive physical disability reflected by a 1-point or more increase in patients' scores on the Expanded Disability Status Scale, or EDSS, Thirty-one patients at the university’s MS clinic who had discontinued Gilenya were included in the study. Eight experienced SDR and 11 relapses. The mean time for SDR patients' reactivation to occur was 2.6 months, researchers said. Patients had significantly higher levels of lymphocytes — white blood cells involved in autoimmunity — than during Gilenya treatment. When the team compared the disease features of SDR and non-SDR patients, they found that SDR patients had significantly higher annualized relapse rates before starting Gilenya and lower EDSS scores. “A higher ARR [annualized relapse rate] is the major contributory factor toward development of SDR,” the researchers wrote. “Patients who had higher ARRs before fingolimod [Gilenya] treatment must be closely followed up both clinically and radiologically in terms of the early signs of severe reactivation,” they wrote. About 38 percent of the SDR patients failed to respond to steroid treatment. They received a plasma exchange, which led to moderate improvement in their condition. Based on this finding, the researchers suggested that “plasmapheresis [plasma exchange] must be considered in patients exhibiting steroid-refractory SDR.” "In conclusion, SDR may be observed within the first 3 months after cessation of fingolimod," the team wrote. "This may be explained by the rapid influx of lymphocytes into the CNS [central nervous system]. Patients with higher annualized relapse rates and lower Expanded Disability Status Scale scores before commencing fingolimod treatment were more likely to exhibit SDR."  

A majority of relapsing-remitting multiple sclerosis (RRMS) patients at a Swedish clinic who initiated treatment with Tecfidera (dimethyl fumarate; DMF) either stopped or switched to another therapy within two years, a study reports. Researchers in the observational study were not able to determine exact reasons for discontinuation. But, they wrote,…

Have you ever thought about stopping whatever MS treatment you’re using? I have. So has John Corboy. Corboy’s not an MS patient. Rather, he’s a researcher at the University of Colorado’s medical school. And he’s studying whether older patients, if they haven’t had a relapse for several…

In case you missed them, here are some news stories that appeared in MS News Today that caught my eye over the past week. Acne Therapy Reduces Rate of Multiple Sclerosis Progression, Canadian Study Reports At first glance, the headlines about this drug announced what seemed to be…

Older patients with secondary progressive multiple sclerosis (SPMS) as well as older relapsing patients whose MS has been inactive after five years may safely discontinue their treatments, Canadian researchers at Vancouver’s University of British Columbia argue. Their Sanofi Genzyme-sponsored study, “When Should Disease-Modifying Treatments Be Discontinued in Patients with Multiple Sclerosis: An…

Many decisions to stop taking the multiple sclerosis treatment Tysabri (natalizumab) appear to be based largely on subjective factors such as patients’ or physicians’ view of the risk, rather than objective assessments of the risk, a study indicates. Tysabri is an approved immunotherapy for active relapsing-remitting multiple sclerosis (RRMS). Despite its benefits, there…

I was a teenager during the 1980s and cannot say the word “holiday” without Madonna’s song playing briefly in my head. For most holidays the perky music seems okay, but for discussion of a “drug holiday” it feels a bit off. Sort of like, “Yay! You have a chronic…

Multiple sclerosis (MS) patients with more advanced disease, as evidenced by disability, and those more frequent relapses or aversion to needles are among the groups of people at higher risk of discontinuing Betaferon (interferon beta-1b) treatment, researchers report. These findings may help to alert clinicians to those least likely to adhere to…

Rebound symptoms after stopping fingolimod (Gilenya) treatment affect a “clinically relevant” number of multiple sclerosis (MS) patients, a study by University of California, San Francisco, researchers reported. The study called attention to the need for determining the best method of sequencing or stopping MS treatments, and highlighted the need to identify factors…