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#Post#: 4924--------------------------------------------------
(ECTRIMS preliminary abstract) Defining optimal profiles for tre
atment discontinuation in older MS patients
By: agate Date: September 11, 2025, 1:30 am
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Abstracts from the upcoming ECTRIMS conference are being
released in advance. They probably aren't in their final format
and so it would be best to wait until the actual conference has
taken place before posting any of them. However, just to try one
out, here is one from Scientific Session 2: Treatment in the
Elderly. I have omitted all but the first author's name, the
authors' affiliations, and their Disclosure
of Interest statements. The authors are from Spain, Italy,
Netherlands, the UK, and Australia.
[quote][font=sage peak]Defining Optimal Profiles for Treatment
Discontinuation in Older MS Patients[/font]
[font=sage peak]
René Carvajal et al.[/font]
Introduction:
The prevalence of aging people with MS (PwMS) is increasing.
Disease modifying therapy (DMT) effectiveness declines with age,
while the risk of adverse events increases. Discontinuing DMT is
an option, but selection of appropriate candidates remains
unclear.
Objectives/Aims:
To characterize DMT discontinuation in PwMS aged ⩾50 and
compare inflammatory and neurodegenerative outcomes with those
who continue treatment.
Methods:
Retrospective study of a prospectively collected cohort (since
1994) at a single centre in Catalonia. PwMS aged ⩾50 on
DMT with ⩾6 months of exposure were included. DMTs were
categorized as first-line, anti-trafficking, or anti-CD20
therapies. Discontinuation was defined as ceasing therapy for
⩾6 months, with incidence and primary causes recorded.
Treatment continuation episodes based on key baselines features
were established using propensity score matching (1:6 ratio). We
assessed outcomes—including inflammatory activity (relapses or
new/contrast-enhancing lesions) and 12-week confirmed disability
worsening (CDW)—using proportional hazards models, and conducted
subgroup analyses.
Results:
Among 563 older PwMS, 113 (20%) discontinued therapy (median
[IQR] age 58 [54-65] yrs; 74% female; median disease duration 21
yrs; median EDSS 5.5; median time free of inflammatory activity
4.5 yrs). Among these, 82 (73%) stopped first-line therapies
(mainly due to tolerability issues), 26 (23%) anti-CD20, and 5
(4%) anti-trafficking (both primarily due to safety
concerns/infections).
Matching yielded 725 patients (109 discontinuation, 616
continuation episodes) with median follow-ups of 5.0 yrs (IQR
3.2–8.9) and 4.2 yrs (IQR 2.1–7.4), respectively. After
baseline, in the discontinuation group, 19.2% experienced
relapses versus 14.1% in the continuation group (p=0.6), while
MRI activity was observed in 40.9% versus 17.9%, respectively
(p<0.005). Discontinuation increased inflammatory risk for
first-line (HR=2.18, 95%CI: 1.50–3.16; p<0.001) and
anti‑trafficking (HR=24.9, 95%CI: 1.99–311; p=0.013), but
not for anti‑CD20 (HR=2.18, 95%CI: 0.78–6.08; p=0.14). In
subgroup analyses, discontinuation increased inflammatory risk
in all groups except patients >60, those on anti‑CD20, and
those treated >10 years. Discontinuation was not associated with
increased CDW risk overall (HR= 0.99, 95%CI: 0.56–1.72; p >0.9)
or in subgroup analyses.
Conclusion:
DMT discontinuation in older PwMS appears feasible for those
over 60, on anti‑CD20, and with over 10 years of
treatment, and was not linked to disability progression.
[/quote]
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