Discontinuing Second-Line DMT Raises Risk of MS Relapse

The risk of relapse was significantly higher in middle-aged patients with multiple sclerosis (MS) who discontinued second-line disease-modifying treatment (DMT) with natalizumab compared with those who discontinued first-line DMT, according to study results published in the Journal of Neurology.

“There has been scant research on the consequences of discontinuing second-line DMT in middle-aged patients with MS,” wrote study lead author Maëlle Chappuis, University Hospital Department of Neurology, Rennes, France, and coauthors. “The objective was therefore to examine the occurrence of focal inflammatory activity after the discontinuation of second versus first-line DMT in patients over 45 years.”

The retrospective study included 232 patients, median age 52.8 years, who had been treated with first-line or second-line DMT for at least 6 months before stopping. Among them, 49 stopped second-line DMT.

The probability of relapse within a year of stopping first-line DMT was 6%, according to the study, compared with 9% for those who stopped second-line DMT with fingolimod. For patients who stopped second-line natalizumab, the probability of relapse within a year was 43%.

After stopping natalizumab or fingolimod, relapse peaked within the first 3 months, the study showed.

Compared with first-line DMT, the hazard ratio for relapse after discontinuing second-line natalizumab was 3.24, reported researchers.

“Our study suggests that the risk of inflammatory activity is greater after discontinuation of natalizumab compared to other DMT even in middle-aged patients,” concluded researchers. “As for younger patients, natalizumab discontinuation should only be considered if there is an adequate substitution of a different therapy.”

Reference:
Chappuis M, Rousseau C, Bajeux E, et al. Discontinuation of second- versus first-line disease-modifying treatment in middle-aged patients with multiple sclerosis. J Neurol. Published online September 16, 2022. doi:10.1007/s00415-022-11341-2