Discontinuation of disease-modifying therapy in MS patients over 60 years old and its impact on relapse rate and disease progression

Salavisa, Manuel; Serrazina, Filipa; Ladeira, Ana Filipa; Correia, Ana Sofia

doi:10.1016/j.clineuro.2023.107612

Cited by 7 publications

(3 citation statements)

References 25 publications

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“…The results of a small, retrospective study in 35 people with MS aged > 60 years supported the findings of this meta-analysis, in that discontinuation of a DMT did not predict a higher frequency of MS relapses or increased progression of disability during a subsequent, 2-year follow-up period [ 48 ]. The post hoc analysis of randomised evaluations of fingolimod, also showed greater effects of the DMT in younger than in older individuals with regard to suppression of relapses and new MRI lesions and achievement of no evidence of disease activity [ 31 ].…”

Section: Changes In the Efficacy Of Disease-modifying Therapy With Agesupporting

confidence: 58%

Narrative Review on the Use of Cladribine Tablets as Exit Therapy for Stable Elderly Patients with Multiple Sclerosis

de Seze,

Dive,

Ayrignac

et al. 2024

Neurol Ther

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The number of ageing people with relapsing multiple sclerosis (RMS) is increasing. The efficacy of disease-modifying therapies (DMTs) for RMS declines with age. Also, older persons with MS may be more susceptible to infections, hospitalisations and malignancy. Aging people with MS have higher rates of comorbidities versus aged-matched controls, increasing the individual risk of disability. We review the therapeutic properties of cladribine tablets (CladT) in ageing people with RMS, with regard to their utility for allowing these individuals to cease continuous administration of a DMT (i.e. to act as an “exit therapy”). CladT is thought to be an immune reconstitution therapy, in that two short courses of oral treatment 1 year apart provide suppression of MS disease activity in responders that far outlasts the duration of treatment and post-treatment reductions in lymphocyte counts. Post hoc analyses, long-term follow-up of populations with RMS in randomised trials, and real-world evidence suggest that the efficacy of CladT is probably independent of age, although more data in the elderly are still needed. No clear adverse signals for lymphopenia or other adverse safety signals have emerged with increasing age, although immunosenescence in the setting of age-related “inflammaging” may predispose elderly patients to a higher risk of infections. Updating vaccination status is recommended, especially against pneumococci and herpes zoster for older patients, to minimise the risk of these infections. CladT may be a useful alternative treatment for ageing people with MS who often bear a burden of multiple comorbidities and polypharmacy and who are more exposed to the adverse effects of continuous immunosuppressive therapy.

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Section: Changes In the Efficacy Of Disease-modifying Therapy With Agesupporting

confidence: 58%

Narrative Review on the Use of Cladribine Tablets as Exit Therapy for Stable Elderly Patients with Multiple Sclerosis

de Seze,

Dive,

Ayrignac

et al. 2024

Neurol Ther

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“…In a small study of 35 pwMS (38.5% RRMS, 61.5% SPMS) over age 60 years from a tertiary clinic in Portugal, 13 discontinued DMTs while the rest continued DMTs. During a mean follow-up of 77 months after discontinuation, the two groups had no difference in relapse and confirmed disease progression [31 ▪ ]. In a study of 498 people with RRMS above 50 years from the population-based Lorraine registry in France, there was no difference in the risk of relapse or disability progression between the 132 patients who discontinued versus 366 who continued DMTs within a mean follow-up period of 7 years [24].…”

Section: Observational Studies Of Disease-modifying Therapy Discontin...mentioning

confidence: 92%

“…We first review the available observational studies, which have limitations and provide mixed answers. Growing number of observational studies [18–25,26 ▪▪ ,27 ▪ ,28–30,31 ▪ ,32] have reported findings relevant to DMT discontinuation in pwMS, while several studies [21,24,25,27 ▪ ,29,30,31 ▪ ,32] compared the risks of inflammatory disease activities and disease progression between patients in older versus younger age groups or examined risks between discontinuation versus continuation over 50 years of age (Table 1). These studies are unblinded and different in sample size, study population characteristics, DMT types, and reasons for discontinuation.…”

Section: Observational Studies Of Disease-modifying Therapy Discontin...mentioning

confidence: 99%

Treatment discontinuation in older people with multiple sclerosis

Zhu,

Xia

2024

Current Opinion in Neurology

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Purpose of review The aim of this review was to examine the evidence for disease-modifying therapies (DMTs) discontinuation in older people with multiple sclerosis (MS). We first summarized aging-associated biological changes that influence MS progression and DMT effectiveness, and then summarized recent evidence in evaluating clinical outcomes of discontinuing DMTs in older people with MS. Recent findings Recent findings provide mixed evidence regarding the outcomes of DMT discontinuation in older people with MS. Retrospective observational studies suggested older age and longer stable duration on DMT before DMT discontinuation were associated with lower risk of relapse in people with MS. However, one randomized clinical trial did not demonstrate the noninferiority of DMT discontinuation. Summary The available clinical evidence examining DMT discontinuation in older people with MS remains inconclusive. More robust evidence from clinical trials and real-world data will be necessary to guide clinical decisions regarding DMT discontinuation in older people with MS.

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De-escalation and Discontinuation of Disease-Modifying Therapies in Multiple Sclerosis

Gross,

Corboy

2024

Curr Neurol Neurosci Rep

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Discontinuation of disease-modifying therapy in MS patients over 60 years old and its impact on relapse rate and disease progression

Cited by 7 publications

References 25 publications

Narrative Review on the Use of Cladribine Tablets as Exit Therapy for Stable Elderly Patients with Multiple Sclerosis

Narrative Review on the Use of Cladribine Tablets as Exit Therapy for Stable Elderly Patients with Multiple Sclerosis

Treatment discontinuation in older people with multiple sclerosis

De-escalation and Discontinuation of Disease-Modifying Therapies in Multiple Sclerosis

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