Risk of Disease Activity After Discontinuation of Disease-Modifying Drugs for Multiple Sclerosis

A recent study aimed to analyze patients with multiple sclerosis (MS) who discontinued disease-modifying drugs (DMDs) and experienced disease activity (DA). The retrospective analysis was conducted at a single academic center from 2020 to 2023. Participants in the study included 930 screened patients with MS. Of these patients, 170 (18.2%) stopped their DMD.

The mean age of these patients was 60.3 years, with an Expanded Disability Status Scale (EDSS) score averaging 3.58. Reasons for discontinuation included side effects (32%), physician recommendation (34%), patient preference (17%), insurance issues (9%), and other factors (9%).

Among the patients who discontinued, 27 (15.8%) developed DA, confirmed by MRI, including 13 with relapses. Notably, the rates of DA postdiscontinuation varied by drug: 58% for fingolimod, 30% for natalizumab, 14% for B-cell-depleting therapy, 13% for teriflunomide/dimethyl fumarate, and 5% for interferon/glatiramer acetate.

The mean age of patients who developed DA was younger (48 years) than those without DA (60 years), and they had lower EDSS scores (2.8 vs 3.58). Furthermore, patients over 60 years of age and those with EDSS scores above 6 had the lowest risk of developing DA after discontinuation.

Overall, the study highlights a higher risk of DA in younger patients with MS. In addition, patients with MS who discontinued the use of fingolimod or natalizumab also had an increased risk of DA.

Reference

Karayi G, Quinones-Herrero N, Martin J, Chaudhry S, Cahill J, Rizvi S. A retrospective analysis of disease-modifying drug discontinuation in patients with multiple sclerosis. Presented at: the American Academy of Neurology 2024 Annual Meeting; October 25-27, 2024; Paradise, NV; Abstract S31.010.