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Multiple Sclerosis => MS - RESEARCH AND NEWS => Topic started by: agate on October 21, 2016, 02:53:46 pm

Title: (Abst.) Discontinuing DMTs in RRMS
Post by: agate on October 21, 2016, 02:53:46 pm

From Multiple Sclerosis Journal, October 19, 2016:

Quote

Discontinuation of disease-modifying therapies in multiple sclerosis – Clinical outcome and prognostic factors

Gabriel Bsteh
Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria

Julia Feige
Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria

Rainer Ehling
Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria

Michael Auer
Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria

Harald Hegen
Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria

Franziska Di Pauli
Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria

Florian Deisenhammer
Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria

Markus Reindl
Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria

Thomas Berger
Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
Clinical Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, Innsbruck 6020, Austria. gabriel.bsteh@i-med.ac.at


Background:

Stable disease course may prompt consideration of disease-modifying treatment (DMT) discontinuation in relapsing–remitting multiple sclerosis (RRMS).

Objective:

To investigate the clinical outcome after DMT discontinuation and to identify predictive factors supporting decision-making.

Methods:

We included 221 RRMS patients, who discontinued DMT after ⩾12 months and had documented follow-up ⩾2 years after discontinuation. Hazard ratios (HRs) with 95% confidence intervals (CIs) regarding relapse and disability progression after DMT discontinuation were calculated from Cox regression models.

Results:

Age >45 years at discontinuation (HR = 0.47, CI = 0.23–0.95, p = 0.038), absence of relapses for ⩾4 years on DMT before discontinuation (HR = 0.29, CI = 0.10–0.82, p = 0.020) and absence of contrast enhancing lesions (HR = 0.46, CI = 0.28–0.78, p = 0.004) were independent predictors of absence of relapse after discontinuation. Age >45 years and absence of relapses ⩾4 years on DMT combined had an HR of 0.06 (CI = 0.01–0.44, p < 0.001). Higher Expanded Disability Status Scale (EDSS) at discontinuation, age >45 years and longer disease duration were significantly associated with disability progression after discontinuation.

Conclusion:

While freedom from further disease activity is generally unpredictable, there is a subset of patients (age ⩾45 years, DMT intake ⩾4 years without evidence of clinical or radiological disease activity) having a high likelihood of remaining relapse-free after DMT discontinuation. However, close clinical monitoring for recurrent disease activity is mandatory after discontinuing treatment.

The abstract can be seen here (http://msj.sagepub.com/content/early/2016/10/20/1352458516675751?papetoc).