MS Speaks

Does Age Affect Long-Term Therapy?

by Jack Burks, MD

(Note: The questions below were sent in by two different clients.)

Q: (a) I was diagnosed with MS in 2003. I was on Avonex for three years, then Copaxone for seven years. I had no relapses and only mild further deterioration overall. My neurologist, an MS specialist, recently took me off my disease-modifying therapy because I turned 60 years of age. Can you comment on the relationship of age to the effectiveness of a long-term therapy?

(b) Is it true that after someone has been living with MS for 20 or 30 years, the need for one of the available disease-modifying drug therapies diminishes? After three or more decades of MS, does the course of the disease typically slow down or even stop in a significant number of cases, if any?

A: You have both asked a very controversial question. Does MS naturally "burn out" at a certain age and does the need for treatment go away? The subject is debated often and very little scientific data are available. In my many years of MS experience, I have found much variability exists between patients.

Before the discovery of DMTs, I thought many patients had slowing of their disease course after age 60 or 65. They clearly had fewer relapses, and the disease progression slowed. However, many still had disease progression and some continued to have relapses.

This leads to another very controversial question. If you stop having relapses, should you stop your disease-modifying therapy? The majority of neurologists with whom I discuss this issue say that they do not stop treatment. They believe that the reason the relapses have stopped, and the disability is less than expected, is because these drugs are working. Therefore, stopping the effective drug will expose a patient to a possible worsening of his or her disease.

In regard to the first question (a), your neurologist has a different viewpoint. I respect your neurologist's position, but I am resistant to stopping a treatment that may be responsible for a good outcome, especially if the patient is tolerating the drug well. Stopping the drug may increase MS damage, and we may have more trouble getting this new disease activity under control. More research is needed before I would feel "safe" in withdrawing treatment. Is it worth taking the gamble?

I believe that this decision, like other MS-treatment choices, should be a "shared decision" between the doctor and the patient. There is no "one size fits all" with MS treatments. Most disease-modifying therapies are only in the body for a few days. If you do stop your Copaxone, I would suggest close monitoring for a possible increase in your MS disease activity, including an MRI evaluation. Should it occur, the MRI may detect early disease re-activation.