Abstract Details

Title Stopping disease modifying therapy in patients over age 50 with presumed benign multiple sclerosis

Topic Multiple Sclerosis

Presentation(s) P8 - Poster Session 8 (8:00 AM-9:00 AM)

Poster/Presentation
Number 9-012

Objective To determine if MS DMTs can be safely discontinued in relapsing-onset patients age 50 or older with a benign course thus far.

Background 20-40% of people with relapsing-onset multiple sclerosis (MS) will never develop a secondarily progressive course (SPMS). This divergence is an age-related phenomenon. Continuing disease modifying therapies (DMTs) when benign MS is suspected is of unclear value.

Design/Methods We identified 134 MS patients age 50 or older who discontinued DMTs for at least 6 months where a benign MS course was suspected from the electronic health record (EHR) at Kaiser Permanente Southern California between 1/2012-6/2018. We used prospectively collected information from the EHR to identify disease course, treatment history, relapses, MRI disease activity and disability level.

Results DMT discontinuation was primarily initiated by the patient (n=119, 88.9%) of whom 44 (32.8%) discussed it with their physician before stopping. The majority discontinued an injectable DMT (n=130, 97%) and were females (89%). At the time of DMT discontinuation, mean and standard deviation (SD) for age was 60.5 years (6.3), disease duration 19.1 (10.3), and time since last relapse 10.7 (6.8). After a mean duration of follow-up of 5.1 years (SD=1.6) post-DMT discontinuation, 5 (3.7%) patients had a relapse, 2 (1.5%) with mild residual deficits, 10 (74.6%) had asymptomatic gadolinium-enhancing and/or new/enlarging T2 MRI lesions and one (0.7%) developed inactive SPMS. The majority (n=126, 94%) remained off DMTs. Six (4.5%) resumed DMTs due to relapse or MRI disease activity.

Conclusions These findings indicate that DMT discontinuation in older patients with suspected benign MS is safe. No patients experienced significant adverse clinical outcomes, although one developed inactive SPMS. Additional studies to confirm our findings, particularly ones with a younger age range, are needed to identify a safe age at which a trial of DMT discontinuation is reasonable.

Authors/Disclosures
Derek J. McFaul, DO (Oregon Neurology) PRESENTER	No disclosure on file
	No disclosure on file
Jessica B. Smith, MPH (Kaiser Permanente)	Ms. Smith has nothing to disclose.
Annette M. Langer-Gould, MD, PhD (Kaiser Permanente Southern California)	An immediate family member of Dr. Langer-Gould has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Annals of American Thoracic Society. The institution of Dr. Langer-Gould has received research support from PCORI. The institution of an immediate family member of Dr. Langer-Gould has received research support from PCORI, ARQ, NIH. Dr. Langer-Gould has a non-compensated relationship as a Voting Member with ICER CTAF Panel that is relevant to �鶹��ýӳ�� interests or activities.

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