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Neurology

Discontinuing high-efficacy therapy for older patients with MS raises relapse risk

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A recent observational cohort study sheds light on the risks associated with discontinuing high-efficacy therapy (HET) for older patients with nonactive multiple sclerosis (MS). The findings provide crucial insights into treatment strategies for this demographic group.

Below are the main takeaways.

Discontinuing High-Efficacy Therapy (HET) Poses Risks: Stopping HET for older patients with nonactive MS can significantly increase the risk of relapse, emphasizing the importance of ongoing treatment to maintain disease stability.

Risk Varies by Therapy Type: The risk of relapse upon discontinuation varied depending on the type of HET used. Therapies impacting immune cell trafficking, such as natalizumab and fingolimod, posed a higher risk compared to anti-CD20 therapy, which depletes B-cells.

Comparable Risk to Younger Patients: The research indicates that older patients, aged 50 and above, face a similar increased risk of relapse upon discontinuing HET as their younger counterparts. This suggests that age may not mitigate the risk associated with treatment discontinuation.

Clinical Decision Making Implications: The findings have significant implications for clinical practice, highlighting the need for careful consideration when deciding to discontinue HET for older patients with nonactive MS. Clinicians should weigh the risks and benefits of treatment continuation versus discontinuation based on individual patient characteristics and therapy type.

Personalized Treatment Approach: The study underscores the importance of personalized treatment approaches in MS management, emphasizing the need for tailored strategies that account for factors such as patient age, disease phenotype, and therapy type to optimize patient outcomes and minimize the risk of disease relapse.

Reference
Jouvenot G, Courbon G, Lefort M, et al; OFSEP Investigators. High-Efficacy Therapy Discontinuation vs Continuation in Patients 50 Years and Older With Nonactive MS. JAMA Neurol. 2024;doi: 10.1001/jamaneurol.2024.0395. Epub ahead of print. PMID: 38526462.

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