Study investigates risk when discontinuing therapy for MS patients over 55 (Likely okay)

Medical Xpress / CU Anschutz Medical Campus / The Lancet Neurology ^ | June 23, 2023 | John R Corboy et al

[ConservativeMind]

An article evaluates the risk of recurrence of active disease in older patients with multiple sclerosis after discontinuing disease-modifying therapies.

Multiple sclerosis (MS) is a chronic illness, often presenting in young adulthood.

Over time, as people age, new attacks and MRI changes become less common, and either patients stabilize, or they may go into a phase of slow progressive neurological disability with minimal MRI changes.

There is no cure for MS, but there are now over 20 disease-modifying therapies (DMTs) that may substantially diminish the risks of new attacks and MRI changes.

The article reports the results of a clinical trial known as DISCOMS, the first randomized, controlled, observer-blinded trial of discontinuation of MS DMTs. Between May 2017 and February 2020, researchers recruited 259 participants over 55 who had not had an acute MS relapse for at least five years and no new MRI lesion for at least three years from 19 MS centers in the United States. Using any new relapse or MRI scan change over two years as the main outcome, the study asked whether it was non-inferior to discontinue compared to staying on DMT.

Only 22/259 (6/128 in the continue group and 16/131 in the discontinue group) total individuals had a new event (relapse or MRI scan change). By this measure, the researchers were unable to show non-inferiority, i.e. it could be inferior to stop DMT, noting that 15/22 of the new events were 1-2 new MRI lesions unaccompanied by any relapse or change in disability, and only four (one continue, three discontinue) participants had an acute relapse. There also was no increase in disability, symptom scores, cognitive tests, or adverse events in those discontinuing DMT.

[ConservativeMind]

It would appear discontinuing therapy can be a reasonable option, once you are beyond the general ages of acute attacks, but it would seem prudent to keep getting MRIs.

[ConservativeMind]

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[chajin]

There is the research being done on clemastine, an old-fashioned antihistamine which some studies indicate could shrink the brain lesions in MS patients.

FD: my wife died two years ago from complications of MS, she was in her early 50s. One of my students from 25 years ago is also an MS patient, and she has been trying to convince someone, anyone to script her clemastine so she could try it herself, but doctors won’t prescribe it off-label for MS—she even tried to get a veterinarian to write a prescription for her dog, but no.

[Macoozie]

MS hits everybody differently.
If the Meds work for you, groovy.
If they don’t, then stop taking them.

It’s chronic and progressive.
You can’t wait around for a perfect treatment to be happy.
Do what works for you, eat healthy, get what exercise activity you can, especially any kind of cardio.

And don’t listen to all the Negative Nancies.

It’s your life, YOU live it.

[lastchance]

I am sorry for your loss.