Should I stay or should I go (on). Disease modifying therapies in patients with no evidence of disease activity for more than five years
ECTRIMS Online Library. Monschein T. 09/11/19; 279014; P654
Tobias Monschein
Tobias Monschein

Abstract: P654

Type: Poster Sessions

Abstract Category: Therapy - Long-term treatment monitoring

T. Monschein, P. Altmann, T. Zrzavy, S. Blechinger, S. Salhofer-Polanyi, P. Rommer, A. Dal-Bianco, T. Berger, F. Leutmezer

Neurology, Medical University of Vienna, Vienna, Austria

Background: Since the approval of Interferon beta (IFNb) and Glatiramer Acetate (GA) for patients with clinically isolated syndrom (CIS), treatment with disease modifying therapies (DMTs) has become standard care in multiple sclerosis (MS) patients with a first clinical episode. Since some patients show no evidence of disease activity (NEDA) over a long period of time, the question might arises in both patients and their treating physicians, about the risk of disease recurrence after stopping DMTs.
Patients and methods: We present a cohort of 49 patients, who started IFNb or GA after the first clinical episode suggestive of MS. Diagnosis of MS was additionally supported by MRI, meeting Barkhof MRI criteria in all patients, and cerebrospinal fluid testing.
After initiation of DMTs patients had to have NEDA status for at least 5 years before they decided to stop therapy exclusively due to freedom of disease activity. After discontinuation of DMTs patients underwent yearly clinical (relapse and expanded disability status scale (EDSS) examination) as well as MRI follow up.
Results: Of 49 patients discontinuing DMTs, 26 had NEDA for at least 5 years of follow up (range 5-8 years), while 23 showed either relapse (n=7), MRI progression (n=10), or both (n=6). The only predictive factor of ongoing freedom of disease activity was age at DMT termination (mean in the ongoing NEDA group 37,3 years compared to 29,9 years in patients with recurrence of disease activity). Patients >45 years of age at the time of DMT discontinuation had a risk of recurrence of disease activity of 10%, while the corresponding number was 56% in patients < 45 years of age. Gender, type of DMT, treatment duration, and CIS symptom did not differ significantly between groups.
Conclusion: In our cohort, older age at the time of DMT discontinuation was the only predictive factor for ongoing NEDA status. This data should not encourage patients to generally stop DMTs after a long period of NEDA. However, it could provide some support to physicians, who have to advise patients that do not longer want to follow DMTs because of long lasting freedom of disease activity.
Disclosure: Referring to this abstract all the authors have nothing to disclose.
Tobias Monschein: nothing to disclose.
Patrick Altmann: nothing to disclose.
Tobias Zrzavy: nothing to disclose.
Stephan Blechinger: nothing to disclose.
Sabine Salhofer-Polanyi: nothing to disclose
Assunta Dal-Bianco: nothing to disclose
Paulus Rommer: nothing to disclose
Thomas Berger: nothing to disclose
Fritz Leutmezer: nothing to disclose

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