Objective:

To analyze patients with Multiple Sclerosis (MS) who discontinue disease modifying drugs
(DMD) and experience disease activity (DA).

Background:

Although several studies have investigated outcomes related to DMD discontinuation, these
results remain inconclusive. Our study aims to investigate the risk of MS disease activity after
drug discontinuation.

Design/Methods:

This was an IRB-approved study. Retrospective analysis was conducted in patients seen at a
single academic center from 2020-2023.

Results:

Out of 930 patients screened, 170 (18.2%) discontinued DMD. Mean age and EDSS were 60.3
years and 3.58, respectively. Patients discontinued DMD due to multiple reasons (side effects:
32%, MD suggestion: 34%, patient preference:17%, Insurance issues: 9%, Misc: 9%). A total of
27 patients (15.8%) developed DA (all had MRI activity, 13 with relapse) after discontinuation
of DMD. The number of patients developing disease activity after discontinuing a specific DMD
were as follows: fingolimod 7/12 (58%), natalizumab 7/23 (30%), B-cell depleting therapy 2/14
(14%), teriflunomide/dimethyl fumarate 4/31 (13%), IFN/glatiramer acetate 5/105 (5%). Mean
age was 48 (only 4 patients were > 60 years) and EDDS was 2.8 (all < or =6.5).

Conclusions:

Patients who developed disease activity after discontinuing DMD were younger (mean age 48)
compared to patients who remained with no disease activity (mean age 60) and had lower
average EDSS scores (2.8 vs 3.58). Patients who discontinued fingolimod and natalizumab were
at higher risk of disease activity after treatment discontinuation (58% and 30%, respectively).
Finally, patients > 60 years and EDSS > 6 were at the lowest risk of disease activity after
discontinuation.