Multiple sclerosis (MS) is a chronic illness that often begins in young adulthood. At the onset, individuals commonly experience acute attacks, or relapses, of intermittent new neurological symptoms such as vision changes, numbness, and weakness. These symptoms may come and go randomly and then either remit completely or incompletely. These relapses are associated with changes in the brain or spine as shown by Magnetic Resonance Imaging (MRI). As people age, new attacks and MRI changes become less common. Patients may stabilize or enter a phase of slow progressive neurological disability with minimal MRI changes.

There is no cure for MS, but there are over 20 disease-modifying therapies (DMTs) that can reduce the risks of new attacks and MRI changes. Most DMTs have been approved for patients 55 and under, with the greatest impact on younger patients and modest effects on older patients. It’s unclear if older patients benefit, and risks may increase with age. Whether to stop DMTs as people age is an important, unanswered question.

The article discusses the results of a clinical trial called DISCOMS, which looked at discontinuing MS disease-modifying therapies (DMTs). The study included 259 participants over 55 years old who had not experienced an MS relapse for at least five years and had no new MRI lesions for at least three years. The trial found that discontinuing DMTs could be inferior to staying on the treatment, as there were more new events in the discontinuation group. However, there was no increase in disability, symptom scores, cognitive tests, or adverse events among those who stopped DMT.

John R. Corboy, MD, a professor of neurology at the University of Colorado School of Medicine, led the study and authored the article. “Our study addresses important concerns about the risks and benefits of disease-modifying therapies as people age. The primary objective of our study was to determine whether it is safe to consider discontinuing treatment for older patients with multiple sclerosis who have had no recent relapse or new MRI activity. Our goal was to provide an estimate of disease recurrence in this context,” Corboy said. He and his colleagues concluded that, while they were unable to demonstrate non-inferiority in the primary outcome, many patients aged 55 and older who have not had a relapse for five or more years might find the low risk of new clinical activity makes a personal discontinuation trial a reasonable option for them.