Discontinuing disease-modifying treatment in older, stable adults with MS

[agate]

An abstract of a study showing that older, stable adults with MS who stopped DMTs did not do any worse over 40 months than similar adults who continued the DMTs.

From Multiple Sclerosis Journal (January 21, 2025)--"DISCOntinuation of disease-modifying treatments in MS: The DISCOMS extension trial":

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[Virginia]

I have read in several publications that older individuals should not be taken off DMTs they had been on for a long time.

[agate]

I've heard that too, Virginia. I guess we can pick our favorite research results.

This part is carefully worded:

we could not demonstrate that discontinuing MS DMTs in older, stable adults was not inferior to continuing DMTs.

but then there is this in the conclusion:

There were no relapses, and new brain MRI lesions (1/30 continuer, 2/44 discontinuers) were uncommon during the extension. Time from primary trial entry to disease event was significantly shorter for subjects in the discontinue group (p = 0.043 from log-rank test).

What it boils down to, apparently, is that it's pretty much each patient's choice whether to stop or continue on a DMT if the person is past 55 and "stable."

[Virginia]

What I read, and I am sorry I can't cite the publication, but it stated that after long term use with the older drugs that discontinuing them could bring about more disability usually about 9 months to a year later. I don't recall reading that it said anything about lesions.

We can experience disabilities without more lesions. Some people do as well without a DMT I am sure. I recall that it said long term use. I have been on one consistently for 24 years with no break. That is the reason I get stressed when I think I might not be able to stay on Rebif due to being able to get it.

[agate]

Virginia, is the availability of Rebif still an issue you're having to deal with? It's been quite a long slog, hasn't it--just trying to get it to continue? This is a shameful situation, that someone with MS who has been taking an established drug successfully for 24 years, suddenly has to fight just to keep it.

[Virginia]

I just got news that my insurance has approved it until the end of this year. I am glad now I changed my Part D coverage to Blue Cross. It wasn't on their formulary either but I had a feeling they would come closer to approving a request for exception to their formulary from my neurologist.

[agate]

That must feel like a reprieve. At least you won't have to worry about it until the end of the year.