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Risk associated with discontinuing therapy depends on specific drug

Conference
ECTRIMS 2024
Doi
https://doi.org/10.55788/428b9f6f
Discontinuation of fingolimod or natalizumab in patients over 50 years old with inactive MS was strongly associated with an increased risk of relapse, which often led to resuming therapy. Consequently, discontinuation of these high-efficacy therapies (HETs) should only be considered with adequate substitution by another treatment, as is the case in younger patients.

A retrospective, multicentre study compared the time to onset of focal inflammatory activity (clinical flare and/or MRI activity) in 2 matched groups of elderly patients with MS who either continued or discontinued HET [1]. Data was extracted from the Observatoire Français de la Sclérose en Plaques (OFSEP) database.

Included were 1,620 participants ≥50 years of age (mean age 58 years) who had relapsing-remitting MS or secondary progressive MS that had been inactive for ≥2 years. Their median Expanded Disability Status Scale (EDSS) score was 4.5, and the median time of disease stability was 4.4 years. Participants were classified into 2 groups: discontinuation (n=1,452) and continuation (n=168); 154 participants in each group were matched via an innovative dynamic propensity score. Time to first relapse, time to first MRI activity, annualised relapse rate (ARR) at 1 and 2 years, and disability progression at 1, 2, and 5 years were compared.

There was a significantly higher risk of increased inflammatory activity in the discontinuation group versus the continuation group. The hazard ratio for the time to first clinical activity after matching was 3.6 (95% CI 2.0–6.5; Plog-rank<0.001). The risk of relapse within 1 year differed according to the type of HET that was discontinued: 33.6% for natalizumab, 16.3% for fingolimod, and 0.0% for anti-CD20 (rituximab or ocrelizumab). Treatment was consequently resumed in 75.6% of natalizumab users, 43.1% of fingolimod users, and 22.4% of anti-CD20 users. Age remained the main protective factor against clinical or MRI activity in the discontinuation group (P=0.044). There was a linear decrease in the risk of inflammatory activity after the age of 50 (-7% per year).

  1. Collongues N, et al. Comparison of high efficacy treatment discontinuation and continuation among stable multiple sclerosis patients after 50. Abstract O129, ECTRIMS 2024, 18–20 September, Copenhagen, Denmark.

 

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