Unmasking the Hidden Threat: Study Exposes Increased Disease Recurrence in Elderly MS Patients Post-Therapy Withdrawal

A recent publication in Lancet Neurology examines the likelihood of disease recurrence in elderly individuals with multiple sclerosis (MS) when they discontinue disease-modifying therapies. MS, a chronic condition commonly emerging during young adulthood, typically manifests as acute attacks with intermittent neurological symptoms.

These symptoms, such as vision alterations, numbness, and weakness, may appear and disappear randomly before fully or partially subsiding. Magnetic Resonance Imaging (MRI) scans often reveal corresponding changes in the brain or spine. As individuals age, the occurrence of new attacks and MRI changes diminishes, and patients either stabilize or enter a phase of gradual, progressive neurological disability with minimal MRI alterations.

While there is no known cure for MS, a range of more than 20 disease-modifying therapies (DMTs) has been developed to significantly reduce the risk of new attacks and MRI changes. Most of these DMTs have primarily been studied in patients aged 55 and below, with the greatest benefits observed among younger patients with recent relapses. The impact on slowing progressive disability, particularly in older patients, is more moderate.

The impact of discontinuing disease-modifying therapies (DMTs) in older patients with multiple sclerosis (MS) remains uncertain, while the potential risks associated with DMTs may escalate as individuals age. To shed light on this vital, unanswered question, this article presents the outcomes of the DISCOMS clinical trial, the first observer-blinded, randomized, and controlled trial investigating the discontinuation of MS DMTs.

Over the course of the study, conducted between May 2017 and February 2020, 259 participants aged 55 and above, who had not experienced an acute MS relapse for at least five years and displayed no new MRI lesions for at least three years, were recruited from 19 MS centers across the United States.

Assessing the main outcome based on the occurrence of new relapses or changes in MRI scans over a two-year period, the study aimed to determine whether discontinuation of DMTs was non-inferior compared to their continued usage. Among the total participants, only 22 individuals (6 from the continuation group and 16 from the discontinuation group) experienced new events, such as relapses or MRI scan changes.

However, the study failed to establish non-inferiority, suggesting the possibility of DMT discontinuation being inferior. Notably, the majority of new events (15 out of 22) involved 1-2 new MRI lesions without any accompanying relapse or disability changes. Acute relapses were observed in only four participants (one from the continuation group and three from the discontinuation group).

Furthermore, discontinuing DMTs did not result in increased disability, symptom scores, cognitive impairments, or adverse events. These findings contribute significant insights into the complex considerations surrounding the discontinuation of DMTs in older patients with MS.

In a recent study funded by the Patient-Centered Outcomes Research Institute and the National Multiple Sclerosis Society, researchers led by Corboy have found valuable insights regarding the discontinuation of disease-modifying therapy in older patients with multiple sclerosis (MS).

While the study did not demonstrate non-inferiority as the primary outcome, it revealed that many patients aged 55 and above, who have been free from relapses for five or more years, may consider a personal discontinuation trial due to the low risk of new clinical activity.

This research will serve as a helpful resource for healthcare providers and MS patients in making informed decisions about the potential discontinuation of disease-modifying therapy as they age.

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