Disease-modifying Therapy Discontinuation and Outcomes of Older People with Multiple Sclerosis (MS) at a Large Academic MS Center in Toronto, Canada
Chia-Chen Tsai1, Fasna Raufdeen2, Raphael Schneider2, James Marriott2, Jiwon Oh2
1Faculty of Medicine, University of British Columbia, 2Division of Neurology, Department of Medicine, St. Michael’s Hospital, University of Toronto
Objective:

To describe the clinical characteristics of older people with multiple sclerosis (pwMS), proportion and reasons for older pwMS to discontinue disease-modifying therapy (DMT), and rates of clinical and MRI disease activity after discontinuation.

Background:
MS typically presents between ages 20 and 40, and DMT use is the standard of care in most pwMS. Prior studies indicate that MS disease activity decreases with age, suggesting that DMTs in older pwMS may not be necessary. Most phase 3 clinical trials exclude older pwMS (>55 years), so the risks and benefits of DMT use in this population remain unclear.
Design/Methods:

Older pwMS were identified from the St. Michael’s Hospital MS Clinic Registry from 06/2015-04/2024. Demographics, clinical characteristics, DMT discontinuation data, and clinical (relapses, disability progression) and radiographical (new/enlarging T2 lesions on sequential MRIs) activity after DMT discontinuation were extracted.

Results:

Of 1828 pwMS, 14% (n=253) discontinued a DMT after age 55 at mean age of 61.3 (SD=5) years and were then followed for 7.9 (SD=4) years. The most common DMTs discontinued among older pwMS were interferon beta agents (n=104, 41%) and glatiramer acetate (n=54, 21%). The most common reasons for discontinuation were transition to secondary progressive MS (n=58, 23%), choice/convenience (n=41, 16%), and tolerability concerns (n=36, 14%). Following discontinuation, 14% (n=35) pwMS had a clinical relapse, and 31% (n=49/160) had MRI disease activity.

Conclusions:

At our center, a small proportion of older pwMS discontinued DMTs after age 55, mainly due to transition to progressive disease, preference, and tolerability concerns. Few relapses and new/enlarging lesions on MRI were reported after discontinuation. Our real-world findings suggest that DMT discontinuation in older pwMS may be a reasonable strategy, potentially impacting future MS management in older patients. Future studies of older pwMS at diverse geographic regions are needed to assess the risk and benefits of discontinuing a wider range of DMTs.

10.1212/WNL.0000000000210851
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