Author Topic: (AAN abst.) Discontinuing DMT in patients w/MS over age 60  (Read 60 times)

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Offline agate

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Presented at the AAN annual meeting in Boston, April 2017:
Quote
Disease Modifying Therapy Discontinuation in Patients with Multiple Sclerosis Over Age
60


Le H. Hua1, Huijun Fan2, Devon Conway1, Tyler G. Kinzy1, Nicolas Thompson1

1
Cleveland Clinic, 2Touro University Nevada

Objective:

To compare clinical and patient-reported outcomes in patients with multiple sclerosis (MS) over age 60 who stop or continue disease-modifying therapy (DMT) after at least 2 years of treatment.

Background:

DMTs in MS have robust effects on inflammatory activity but less on disability. The immune system becomes less functional with age and it is unclear whether continued immunomodulation remains beneficial in older patients.

Currently there is insufficient data regarding the necessary duration of DMT or impact of discontinuation to guide such decisions.

Design/Methods:

724 total patients were identified from our MS specialty clinics who were over age 60, on DMT for >2 years, with Knowledge Program entries (database of clinician and patient-reported outcomes). Those who discontinued DMT were compared to those continuing treatment. Data points included: disease course, comorbidities, medications, MRI activity, Patient Health Questionnaire, Multiple Sclerosis Performance Scales, and European Quality of Life.

Demographic differences were assessed with univariate analyses and differences in outcomes will be assessed with multivariate mixed-effects regression models.

Results:

211 patients (29.1%) discontinued therapy during the study period. Discontinuers were older (68.6 +/-4.0 versus 66.7 +/-4.1, p <0.0001), had longer disease duration (21 +/-9.4 versus 18.4 +/-9.4, p<0.001), and less DMT duration (12.5 +/-5.2 versus 14.2 +/- 5.5, p<0.001).

 Providers initiated DMT discontinuation more often than patients (N=144; 68.3%). Primary reasons for discontinuation included side effects (N=102; 48.3%), clinical
stability (N=61; 28.9%), age (N=48, 22.7%), and secondary progression (N=42; 19.9%). 9.5% of discontinuers (N=20) later reinitiated DMT, with reasons: patient preference (N=8; 40.0%), MRI changes (N=4; 20.0%), clinical progression (N=5; 25.0%), and provider preference (N=3; 45.0%).

Conclusions:

Most patients over age 60 who discontinued DMT after at least 2 years treatment, remained off DMT, with very low rates of MRI changes or clinical progression leading to reinitiation. This may help guide clinicians and patients considering DMT discontinuation.
MS Speaks--online for 13 years

SPMS, diagnosed 1980. Avonex 2001-2004. Copaxone 2007-2010.

 

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