Objective:

To evaluate safety of discontinuing injectable disease-modifying therapies (DMT) in aging patients with relapsing-remitting Multiple Sclerosis (RRMS) with both clinical outcomes and OCT as a measure of neurodegeneration. 

Background:

While several studies have suggested stopping DMT may be safe in patients over 55 years old with at least two years without active relapses, there are no studies demonstrating clinical, radiographic stability, including OCT measurements to detect neurodegeneration.

Design/Methods:

Patients from a single MS clinic at the University of Utah between ages 46-86 who had either discontinued DMT (glatiramer acetate or interferon beta 1a) or were planning to discontinue were included. All participants had regular interval MRI scans, received a baseline OCT test, and followed clinically for signs and symptoms of relapse or progression. We have completed follow up OCT testing on nine patients, with the remaining scheduled in the coming months. We are comparing total macular volume (TMV) before and after stopping DMT. Eyes with retinal disease or glaucoma are excluded from analysis. 

Results:

Prospective study of 40 patients, 3 never on DMT, 1 still on DMT, and 36 off. Patients were on average 24.9 years out from MS diagnosis with average treatment duration of 240 months, and average discontinuation age of 64.7. No patients demonstrated clinical or radiographic evidence of relapse in the average 47.4 months after stopping DMT. Preliminary OCT comparisons (9 patients) show no statistically significant change in TMV in right eye (p=0.593) or left eye (p=0.11). 

Conclusions:

Our initial results demonstrate stability of clinical metrics in older patients discontinuing injectable DMTs. OCT measurements will provide insight into the potential for ongoing neurodegeneration following DMT discontinuation.