Medication withdrawal may be an option for a select group of patients in relapsing-remitting multiple sclerosis

Olival, Guilherme Sciascia do; Cavenaghi, Vitor Breseghello; Serafim, Vitor; Thomaz, Rodrigo Barbosa; Tilbery, Charles Peter

doi:10.1590/0004-282x20130081

Cited by 8 publications

(4 citation statements)

References 22 publications

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“…Recently, an observational study described the clinical and radiological evolution of a stable group of 40 patients with RR‐MS who suspended DMT after 5 years of treatment: 90% of patients were attack‐free, 85% showed stable MRI and 97.5% EDSS stability. However, this study is weakened by the small sample size, the selection of participating subjects and the lack of a control group.…”

Section: Discussionmentioning

confidence: 99%

Treatment withdrawal in relapsing−remitting multiple sclerosis: a retrospective cohort study

Lus

Signoriello

Maniscalco

et al. 2015

Euro J of Neurology

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Section: Discussionmentioning

confidence: 99%

Treatment withdrawal in relapsing−remitting multiple sclerosis: a retrospective cohort study

Lus

Signoriello

Maniscalco

et al. 2015

Euro J of Neurology

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“…Accordingly, the effectiveness of treatments declines as patients age, whereas the risk of treatment-related adverse effects increases . Moreover, most of the retrospective studies on medium-efficacy therapy (MET) discontinuation including older patients with nonactive MS are reassuring . A recent randomized clinical trial, the Discontinuation of Disease Modifying Therapies (DMTs) in Multiple Sclerosis (MS) (DISCOMS) trial, focused on treatment discontinuation among patients older than 55 years with nonactive disease .…”

Section: Introductionmentioning

confidence: 99%

High-Efficacy Therapy Discontinuation vs Continuation in Patients 50 Years and Older With Nonactive MS

Jouvenot,

Courbon,

Lefort

et al. 2024

JAMA Neurol

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ImportanceA recent randomized clinical trial concluded that discontinuing medium-efficacy therapy might be a reasonable option for older patients with nonactive multiple sclerosis (MS), but there is a lack of data on discontinuing high-efficacy therapy (HET). In younger patients, the discontinuation of natalizumab and fingolimod is associated with a risk of rebound of disease activity.ObjectiveTo determine whether discontinuing HET in patients 50 years and older with nonactive MS is associated with an increased risk of relapse compared with continuing HET.Design, Setting, and ParticipantsThis observational cohort study used data from 38 referral centers from the French MS registry (Observatoire Français de la Sclérose en Plaques [OFSEP] database). Among 84704 patients in the database, data were extracted for 1857 patients 50 years and older with relapsing-remitting MS treated by HET and with no relapse or magnetic resonance imaging activity for at least 2 years. After verification of the medical records, 1620 patients were classified as having discontinued HET or having remained taking treatment and were matched 1:1 using a dynamic propensity score (including age, sex, disease phenotype, disability, treatment of interest, and time since last inflammatory activity). Patients were included from February 2008 to November 2021, with a mean (SD) follow-up of 5.1 (2.9) years. Data were extracted in June 2022.ExposuresNatalizumab, fingolimod, rituximab, and ocrelizumab.Main Outcomes and MeasuresTime to first relapse.ResultsOf 1620 included patients, 1175 (72.5%) were female, and the mean (SD) age was 54.7 (4.8) years. Among the 1452 in the HET continuation group and 168 in the HET discontinuation group, 154 patients in each group were matched using propensity scores (mean [SD] age, 57.7 [5.5] years; mean [SD] delay since the last inflammatory activity, 5.6 [3.8] years; mean [SD] follow-up duration after propensity score matching, 2.5 [2.1] years). Time to first relapse was significantly reduced in the HET discontinuation group compared with the HET continuation group (hazard ratio, 4.1; 95% CI, 2.0-8.5; P &lt; .001) but differed between HETs, with a hazard ratio of 7.2 (95% CI, 2.1-24.5; P = .001) for natalizumab, 4.5 (95% CI, 1.3-15.5; P = .02) for fingolimod, and 1.1 (95% CI, 0.3-4.8; P = .85) for anti-CD20 therapy.Conclusion and RelevanceAs in younger patients, in patients 50 years and older with nonactive MS, the risk of relapse increased significantly after stopping HETs that impact immune cell trafficking (natalizumab and fingolimod). There was no significant increase in risk after stopping HETs that deplete B-cells (anti-CD20 therapy). This result may inform decisions about stopping HETs in clinical practice.

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“…Aspects related to the treatment of MS, such as drug migration, treatment failure, and adverse effects of immunomodulatory drugs in Brazilian patients 21,22,23,24 .…”

mentioning

confidence: 99%

Professor Emeritus Charles Peter Tilbery [1944-2020]

Moreira¹,

Sanvito

Melges

2020

Arq. Neuro-Psiquiatr.

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Medication withdrawal may be an option for a select group of patients in relapsing-remitting multiple sclerosis

Cited by 8 publications

References 22 publications

Treatment withdrawal in relapsing−remitting multiple sclerosis: a retrospective cohort study

Treatment withdrawal in relapsing−remitting multiple sclerosis: a retrospective cohort study

High-Efficacy Therapy Discontinuation vs Continuation in Patients 50 Years and Older With Nonactive MS

Professor Emeritus Charles Peter Tilbery [1944-2020]

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