Which Patients Who Stop MS Drug Therapy Are Most at Risk of Relapse?

Discontinuing disease-modifying therapies (DMTs) is common among patients with multiple sclerosis (MS), but stopping DMTs can be associated with an increased risk of progression of disease or relapse of disease.

In a new observational cohort study, a group of researchers based at the NYU School of Medicine in New York used the MSBase Neuro-Immunology Registry, an international online database for neurologists studying MS and other neuroimmunologic diseases, to investigate the predictors of MS relapse and confirmed disability progression (CDP) in patients who stopped DMTs.

The study included 4842 MS patients in the registry who were 18 years or older, who had been on a DMT (interferon beta, glatiramer acetate, natalizumab, or fingolimod) for at least 12 months before discontinuing it, and who had stopped their DMT for greater than 6 months.

After analyzing the patients’ data, the researchers found that during the post-DMT period, the annualized relapse rate was 0.22 and the confirmed disability (CDP) progression rate was 8.23 per 100 person-years. They observed that younger and moderately disabled patients had the highest risk of relapse after DMT discontinuation, and that the more severe the MS-related impairment was at baseline, the higher the risk of CDP after stopping therapy. In particular, former natalizumab users had higher relapse and CDP rates than did former users of other DMTs.

“Knowledge of post-DMT relapse and disability progression rates and predictors of post-DMT disease activity allows for a more informed discussion of DMT discontinuation in those patients who are considering this option,” the researchers concluded.

The study findings were published in the August 15, 2018, issue of the Journal of the Neurological Sciences.

—Michael Gerchufsky

Reference:

Kister I, Spelman T, Patti F, et al. Predictors of relapse and disability progression in MS patients who discontinue disease-modifying therapy. J Neurol Sci. 2018;391:72-76. doi:https://doi.org/10.1016/j.jns.2018.06.001.