Caution is needed when discontinuing DMT in individuals under 60

Findings of a retrospective Spanish study support a cautious approach to discontinuing disease-modifying treatment (DMT) in multiple sclerosis (MS) patients aged 50-60 years. Discontinuation appears safer in patients over 60, but even then, systematic MRI monitoring is still advised.

The MS population is ageing: over half of all MS patients are now ≥50 years of age. The effectiveness of DMT declines with age, while the risk of adverse events increases. Discontinuing DMT is an option, but the optimal patient profile for this approach has yet to be established. Therefore, Dr René Carvajal (Vall Hebron University Hospital, Spain) and colleagues conducted a study to characterise DMT discontinuation and compare inflammatory and neurodegenerative outcomes in patients who discontinued versus those who continued treatment [1]. They included patients with MS aged ≥50 years who had received DMT for at least 6 months between 1994 and 2024.

Among 3,197 older MS participants in the prospective cohort, 563 were eligible for inclusion. Of these, 113 (20%) discontinued therapy. Their median age was 58 years; median disease duration, 21 years; median Expanded Disability Status Scale (EDSS), 5.5; and median time free of inflammatory activity, 4.5 years.

Of these 113 participants, 82 (73%) stopped first-line therapies (mainly due to tolerability issues), 26 (23%) discontinued anti-CD20 treatment, and 5 (4%) stopped anti-trafficking therapy (both primarily due to safety concerns/infections).

Results after a median follow-up of about 5 years were compared with those of 581 patients who continued therapy. In patients aged ≥50 years, discontinuation was associated with higher inflammatory activity, with the highest levels observed in those previously treated with anti-CD20 agents and the lowest in the first-line therapy group. MRI activity was also higher, but did not translate into a clear clinical impact. In the discontinuation group, 19.2% experienced relapses versus 14.1% in the continuation group (P=0.6); MRI activity was observed in 40.9% versus 17.9%, respectively (P<0.005).

The risks associated with discontinuation were attenuated in patients younger than 60 years and were not linked to disease stability or treatment duration. In patients over 60, the likelihood of resuming therapy was 93% lower than in those aged 50-55 years. Dr Carvajal stressed that anti-trafficking therapies should not be withdrawn without a clear exit strategy.

1. Carvajal R. Defining optimal profiles for treatment discontinuation in older MS patients. O006, ECTRIMS 2025 Congress, 24-26 September 2025, Barcelona, Spain.

Medical writing support was provided by Michiel Tent.

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Posted on 26 September 2025