Discontinuation of MS Disease-Modifying Therapies Impacts Disease Activity Risk

Patients with multiple sclerosis (MS) who discontinued disease-modifying therapies (DMTs), such as fingolimod and natalizumab, had a higher risk of developing disease activity, according to study results presented at the 2024 American Academy of Neurology (AAN) annual meeting, held from April 13 to 18, 2024, in Denver, Colorado.

Due to inconclusive results from previous studies, researchers conducted a retrospective analysis to evaluate the effect of DMT discontinuation on risk for disease activity in MS.

A total of 930 patients (mean age, 48; mean Expanded Disability Status Scale [EDSS] score, 2.8) with MS were identified for the study from a single academic center. Of these, 170 (18.2%) had discontinued DMTs; the most common reason for DMT discontinuation was suggestion by provider (34%), followed by occurrence of side effects (32%) and individual patient preferences (17%).

The researchers observed disease activity on magnetic resonance imaging (MRI) in 27 patients (15.8%) after DMT discontinuation, of whom 13 had MS relapse. Specifically, 58% of patients who received fingolimod, 30% who received natalizumab, 14% B-cell depleting therapy, 13% teriflunomide/dimethyl fumarate, and 5% who received interferon (IFN)/glatiramer acetate all developed disease activity after DMT discontinuation.

Patients who were older than age 60 and had EDSS scores of greater than 6 had the lowest risk for disease activity after DMT discontinuation.

Overall, the researchers concluded, “Patients who developed disease activity after discontinuing DMD [disease-modifying drugs] were younger … compared to patients who remained with no disease activity … and had lower average EDSS scores …”