Abstracts from the upcoming ECTRIMS conference are being released in advance. They probably aren't in their final format and so it would be best to wait until the actual conference has taken place before posting any of them. However, just to try one out, here is one from Scientific Session 2: Treatment in the Elderly. I have omitted all but the first author's name, the authors' affiliations, and their Disclosure
of Interest statements. The authors are from Spain, Italy, Netherlands, the UK, and Australia.
Defining Optimal Profiles for Treatment Discontinuation in Older MS Patients
René Carvajal et al.
Introduction:
The prevalence of aging people with MS (PwMS) is increasing. Disease modifying therapy (DMT) effectiveness declines with age, while the risk of adverse events increases. Discontinuing DMT is an option, but selection of appropriate candidates remains unclear.
Objectives/Aims:
To characterize DMT discontinuation in PwMS aged ⩾50 and compare inflammatory and neurodegenerative outcomes with those who continue treatment.
Methods:
Retrospective study of a prospectively collected cohort (since 1994) at a single centre in Catalonia. PwMS aged ⩾50 on DMT with ⩾6 months of exposure were included. DMTs were categorized as first-line, anti-trafficking, or anti-CD20 therapies. Discontinuation was defined as ceasing therapy for ⩾6 months, with incidence and primary causes recorded.
Treatment continuation episodes based on key baselines features were established using propensity score matching (1:6 ratio). We assessed outcomes—including inflammatory activity (relapses or new/contrast-enhancing lesions) and 12-week confirmed disability worsening (CDW)—using proportional hazards models, and conducted subgroup analyses.
Results:
Among 563 older PwMS, 113 (20%) discontinued therapy (median [IQR] age 58 [54-65] yrs; 74% female; median disease duration 21 yrs; median EDSS 5.5; median time free of inflammatory activity 4.5 yrs). Among these, 82 (73%) stopped first-line therapies (mainly due to tolerability issues), 26 (23%) anti-CD20, and 5 (4%) anti-trafficking (both primarily due to safety concerns/infections).
Matching yielded 725 patients (109 discontinuation, 616 continuation episodes) with median follow-ups of 5.0 yrs (IQR 3.2–8.9) and 4.2 yrs (IQR 2.1–7.4), respectively. After baseline, in the discontinuation group, 19.2% experienced relapses versus 14.1% in the continuation group (p=0.6), while MRI activity was observed in 40.9% versus 17.9%, respectively (p<0.005). Discontinuation increased inflammatory risk for first-line (HR=2.18, 95%CI: 1.50–3.16; p<0.001) and anti‑trafficking (HR=24.9, 95%CI: 1.99–311; p=0.013), but not for anti‑CD20 (HR=2.18, 95%CI: 0.78–6.08; p=0.14). In subgroup analyses, discontinuation increased inflammatory risk in all groups except patients >60, those on anti‑CD20, and those treated >10 years. Discontinuation was not associated with increased CDW risk overall (HR= 0.99, 95%CI: 0.56–1.72; p >0.9) or in subgroup analyses.
Conclusion:
DMT discontinuation in older PwMS appears feasible for those over 60, on anti‑CD20, and with over 10 years of treatment, and was not linked to disability progression.
