DMT discontinuation poses risk of recurrence even in patients with long-term stable MS

For people with long-term stable multiple sclerosis (MS) who use disease-modifying therapy (DMT) in the first-line setting, discontinuation spells an increased hazard of inflammatory disease activity recurrence, as shown in a study.

The study included 89 adult patients (median age 54.0 years, 67.4 percent female) who had relapse-onset MS (relapsing-remitting MS or secondary progressive MS), used first-line DMT, and had neither clinical relapses nor substantial radiological disease activity for at least 5 years before inclusion. These patients were randomly assigned to discontinue (n=45) or continue (n=44) their first-line DMT.

The primary outcome of significant inflammatory disease activity, defined as relapse and/or at least three new T2 lesions or at least two contrast-enhancing lesions on brain MRI.

Two patients in the continue group were lost to follow-up. The trial was prematurely terminated due to the cases of inflammatory disease activity recurrence exceeding the predefined limit. The median follow-up duration was 15.3 months.

Results showed that eight patients (17.8 percent) in the discontinue group and none in the continue group had significant inflammatory disease activity, mostly radiological inflammation. Of the eight patients, two had a clinical relapse, with a median time to disease activity of 12.0 months.

The findings provide for informed decision-making in cases when treatment discontinuation is considered for patients with long-term stable MS. According to the researchers, while an attempt to discontinue first-line DMT in long-term stable patients with MS is still a viable option, close clinical, radiological, and biomarker-based monitoring is required.