MS Speaks

Mult Scler Relat Disord. 2017 Feb;12:82-87.

Discontinuation of disease modifying treatments in middle aged multiple sclerosis patients. First line drugs vs natalizumab

Fagius J1, Feresiadou A2, Larsson EM3, Burman J2.

Author information

1
Department of Neuroscience, Uppsala University, Uppsala, Sweden. Electronic address: jan.fagius@neuro.uu.se.
2
Department of Neuroscience, Uppsala University, Uppsala, Sweden.
3
Department of Surgical Sciences/Radiology, Uppsala University, Uppsala, Sweden.

BACKGROUND:

Several disease-modifying drugs (DMD) are available for the treatment of MS, and most patients with relapsing-remitting disease are currently treated. Data on when and how DMD treatment can be safely discontinued are scarce.

METHODS:

Fifteen MS patients, treated with natalizumab for >5 years without clinical and radiological signs of inflammatory disease activity, suspended treatment and were monitored with MRI examinations and clinical follow-up to determine recurrence of disease activity. This group was compared with a retrospectively analysed cohort comprising 55 MS patients treated with first-line DMDs discontinuing therapy in the time period of 1998-2015 after an analogous stable course.

RESULTS:

Natalizumab discontinuers were followed for on average 19 months, and follow-up data for 56 months were available for first-line DMD quitters. Two-thirds of natalizumab treated patients experienced recurrent inflammatory disease activity, and one third had recurrence of rebound character. In contrast, 35% of first-line DMD quitters had mild recurrent disease activity, and no one exhibited rebound.

CONCLUSIONS:

Withdrawal of a first-line DMD after prolonged treatment in middle-aged MS patients with stable disease appears to be relatively safe, while natalizumab withdrawal in a similar group of patients cannot be safely done without starting alternative therapy.