MS Treatment-Discontinuation Study Terminated After Disease Activity Returns

A randomized trial testing whether first-line disease-modifying therapy (DMT) for multiple sclerosis could be discontinued in people with stable disease was terminated early after several patients who stopped treatment had new disease activity. The study results were presented at the joint meeting of the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) and the American Committee for Treatment and Research in Multiple Sclerosis (ACTRIMS).

In this exclusive MedPage Today video, Gabrielle Macaron, MD, from the Université de Montréal, discusses the findings from the DOT-MS study and how they differ from those of DISCOMS, the first randomized discontinuation trial of MS drugs.

Following is a transcript of her remarks:

It’s the first 5 years of the disease usually that are the most active. So it actually makes sense, we should ask ourselves this question for platform therapies. So in this trial they looked at patients who are older than 18, who like I said, have been stable for a minimum of 5 years and who were either on injectables, Copaxone [glatiramer acetate] or interferons, or teriflunomide [Aubagio].

So they enrolled 89 patients and they randomized them, half to either stop or continue their therapy. And the mean age of [patients at] inclusion was 53 years. So it wasn’t a young, young population. And the median follow-up was 12 years. But this study was prematurely discontinued, even in this scenario, because there were several patients in the discontinuation group that had recurring disease activity. So it was the criteria to prematurely stop the study and that’s what they did.

And these patients [with inflammatory disease activity] had a mean age of 49 years, so a bit younger than the mean. But they did not really differ in regards to which DMT they were taking or for how long they have been stable on this DMT compared to those who remained unstable.

I think this study really highlights again that stopping medication in somewhat younger patients, even platform DMT, poses a risk of reactivation of the disease. And platform therapies do work sometimes.

So, like I said, it’s very different from DISCOMS because I think when we think of our patients who are 65 or 68 or 70 who have had MS for 30 years, they’re different than this population. And I don’t think we should treat them the same way. And from what I see from patients who have longstanding disease, I feel like disease duration is the main factor that makes you think that the disease is burned out.

Some patients do develop the disease at 55 and those maybe have 10, 15 years of treatment that they should take. But people who are older and we stop their platform therapy, they do fine, right? A 68-year-old for whom you stop Copaxone, who’s been taking it for 25 years, they just do fine, I think.

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