Presented at the annual AAN conference in Vancouver, BC, April 2016:
S24.002 - Can we stop immunomodulatory treatment in secondary progressive MS?
April 18, 2016, 3:45 PM - 4:00 PM
Authors
Julien Bonenfant,1 Veronique Deburghgraeve,2 Emmanuelle Le Page,1 Gilles Edan,3 Anne Kerbrat,2 Bajeux Emma1
1Rennes, France, 2, 3Cedex, France
Disclosures
J. Bonenfant: None. V. Deburghgraeve: ; received compensation as a consultant with Bayer, Biogen-Idec ,Teva ,Novartis, Genzyme. E. Le Page: ; received compensation as a consultant with Bayer, Biogen-Idec ,Teva ,Novartis, Genzyme, No, No, No, No, No. G. Edan: ; Gilles Edan has received compensation as a consultant with Bayer, Biogen-Idec ,Teva ,Novartis, LFB.. A. Kerbrat: None. B. Emma: None.
Objective:
1) To describe the clinical and radiological outcome in SPMS patients after immunomodulatory treatment discontinuation
2) To identify factors associated with relapses and/or MRI activity of the disease after treatment discontinuation.
Background:
In secondary progressive MS (SPMS), immunomodulatory treatment [has] not shown significant effect on disability progression. [Whether or not to continue these costly treatments has] become a common issue in clinical practice for patients who have reached [the] secondary progressive phase. However, the impact of treatment discontinuation on relapse rate remains unknown.
Methods:
SPMS patients included in the EDMUS database of Rennes University hospital (France) were retrospectively selected.
Patients had 1) to be treated at least 6 months with an immunomodulatory treatment (interferonβ or glatiramer acetate), 2) to have stopped the treatment without [planning to switch], 3) to be followed at least 1 year after treatment discontinuation.
Clinical data (relapses, EDSS) and radiological data (restricted to gadolinium-enhancing lesions) before and after treatment discontinuation were assessed. Factors associated with relapses and/or MRI activity were identified using multivariate Cox proportional hazard model.
Results:
106 SPMS patients were included. The mean treatment duration was 5.0 ± 3.1 years. The mean follow up after treatment discontinuation was 5.2 ± 3.2 years. Seventeen patients experienced a relapse after discontinuation and 37 had clinical and/or radiological activity. The annual relapse rate remained stable at 1 year (0.09) and 3 years (0.07) after treatment discontinuation compared to 3 years (0.13) before discontinuation. Radiological activity in the 3 previous years and an EDSS < 6 were associated with [an] inflammatory event after discontinuation (p=0.03 and p=0.05 respectively). Treatment was finally resumed in 30 patients.
Conclusions:
Treatment discontinuation in SPMS patients was not associated with an increase in annualized relapse rate compared to [the rate for those on treatment].