Comparison of brain atrophy in patients with multiple sclerosis treated with first‐ versus second‐generation disease modifying therapy without clinical relapse

2020 ◽  
Vol 27 (10) ◽  
pp. 2056-2061
Author(s):  
H. Masuda ◽  
M. Mori ◽  
S. Hirano ◽  
A. Uzawa ◽  
T. Uchida ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Brain Atrophy ◽  
Second Generation ◽  
Clinical Relapse ◽  
Disease Modifying Therapy ◽  
Disease Modifying

Discontinuation of disease-modifying therapy in patients with multiple sclerosis over age 60

2018 ◽  
Vol 25 (5) ◽  
pp. 699-708 ◽  
Author(s):  
Le H Hua ◽  
Tracey H Fan ◽  
Devon Conway ◽  
Nicolas Thompson ◽  
Tyler G Kinzy
Keyword(s):  
Multiple Sclerosis ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Clinical Relapse ◽  
Real World Data ◽  
Disease Modifying Therapy ◽  
Patient Reported ◽  
Relapsing Remitting ◽  
Patient Health ◽  
Disease Modifying

Background: The risk–benefit ratio of continuing immunomodulating disease-modifying therapy (DMT) in older multiple sclerosis (MS) patients is unknown. Objective: To evaluate clinical and patient-reported outcomes after stopping DMT in older MS patients. Methods: Retrospective, observational study identifying patients from our MS clinics who were aged over 60 and on DMT > 2 years. Cause-specific Cox proportional hazards regression modeled time to discontinuation and time to reinitiation of therapy. Pre- and post-discontinuation comparisons of Performance Scales (PS), Timed 25-Foot Walk, and Patient Health Questionnaire-9 (PHQ9) were analyzed using linear mixed models. Results: A total of 600 patients were included, with 178 (29.7%) discontinuing. Discontinuers were 2.2 years older, had 3.2 years longer disease duration, and 1.6 years lesser treatment exposure. Providers initiated discontinuation more than patients (68.0%). Only one clinical relapse occurred in discontinuers. A proportion (10.7%) reinitiated DMT. Provider-initiated discontinuers restarted less often (hazard ratio (HR): 0.34; 95% confidence interval (CI): 0.12–0.9). In discontinuers, relapsing-remitting patients had lower PS on average than primary progressive. Provider-initiated discontinuation was associated with lower PS than patient- initiated discontinuation. PHQ9 scores appeared higher in those stopping intravenous (IV) therapies than interferons. Lower PS and PHQ9 indicate better outcomes. Conclusion: Most patients over age 60, who discontinued DMT, remained off DMT. This study provides real-world data that may guide clinicians considering discontinuing DMT.

scholarly journals Examining the effects of comorbidities on disease-modifying therapy use in multiple sclerosis

Neurology ◽  
2016 ◽  
Vol 86 (14) ◽  
pp. 1287-1295 ◽  
Author(s):  
Tingting Zhang ◽  
Helen Tremlett ◽  
Stella Leung ◽  
Feng Zhu ◽  
Elaine Kingwell ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Disease Modifying Therapy ◽  
Disease Modifying

Adherence of Adolescents to Multiple Sclerosis Disease-Modifying Therapy

2009 ◽  
Vol 41 (2) ◽  
pp. 119-123 ◽  
Author(s):  
Jennifer E. Thannhauser ◽  
Jean K. Mah ◽  
Luanne M. Metz
Keyword(s):  
Multiple Sclerosis ◽  
Disease Modifying Therapy ◽  
Multiple Sclerosis Disease ◽  
Disease Modifying

scholarly journals Stopping Disease-Modifying Therapy in Nonrelapsing Multiple Sclerosis

2017 ◽  
Vol 19 (1) ◽  
pp. 11-14 ◽  
Author(s):  
Gary Birnbaum
Keyword(s):  
Multiple Sclerosis ◽  
Acute Disease ◽  
Published Data ◽  
Secondary Progressive ◽  
Disease Modifying Therapy ◽  
Scale Scores ◽  
Group A ◽  
Multiple Variables ◽  
Disease Modifying ◽  
Group B

Background: Current disease-modifying therapies (DMTs) are of benefit only in people with relapsing forms of multiple sclerosis (RMS). Thus, safely stopping DMTs in people with secondary progressive MS may be possible. Methods: Two groups of patients with MS were studied. Group A consisted of 77 patients with secondary progressive MS and no evidence of acute central nervous system inflammation for 2 to 20 years. These patients were advised to stop DMTs. Group B consisted of 17 individuals with RMS who stopped DMTs on their own. Both groups were evaluated at treatment cessation and for a minimum of 1 year thereafter. Multiple variables were assessed to determine those that predicted recurrent acute disease. Results: Nine patients in group A (11.7%) and ten patients in group B (58.8%) had recurrent acute disease, almost always within 1 to 2 years of stopping treatment. The only variable of significance in group A distinguishing stable and relapsing patients was age (P = .0003), with relapsing patients being younger. Group B patients were younger and had significantly lower Expanded Disability Status Scale scores than group A, with no significant differences in age between relapsed and stable patients. Conclusions: The DMTs can be stopped safely in older patients with MS (≥7 decades) with no evidence of acute disease for 2 years or longer, with an almost 90% probability of remaining free of acute recurrence. The high proportion of untreated patients with RMS experiencing recurrent acute disease is consistent with published data.

scholarly journals Incidence of malignancy in multiple sclerosis: A cohort study in the Danish Multiple Sclerosis Registry

2021 ◽  
Vol 7 (4) ◽  
pp. 205521732110539
Author(s):  
Mette Nørgaard ◽  
Katalin Veres ◽  
Finn T Sellebjerg ◽  
Lise S Svingel ◽  
Caroline Foch ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Skin Cancer ◽  
General Population ◽  
Incidence Rates ◽  
Disease Modifying Therapy ◽  
Non Melanoma Skin Cancer ◽  
General Population Cohort ◽  
Disease Modifying ◽  
Rate Ratios ◽  
Melanoma Skin

Background The association between multiple sclerosis and malignancy is controversial and a current appraisal is needed. Objective To determine the incidence of malignancy in patients with multiple sclerosis compared with the general population and in relation to disease-modifying therapy. Methods Patients with multiple sclerosis (1995 – 2015) were matched by birth year and sex to individuals without multiple sclerosis in the general population. Patients with multiple sclerosis initiating disease-modifying therapy were evaluated using landmark period analysis. Malignancy risk was assessed by incidence rates, incidence rate ratios, and standardised incidence ratios. Results The standardised incidence ratio of any malignancy (excluding non-melanoma skin cancer) in patients with multiple sclerosis ( n = 10,557) was 0.96 (95% CI 0.88 – 1.06), and there was no increased incidence of specific malignancy types compared with the general population cohort ( n = 103,761). At the 48-month landmark period, the age-adjusted incidence per 100,000 person-years of any malignancy (excluding non-melanoma skin cancer) was 436.7 (95% CI 361.0 – 512.4) in patients newly treated with immunomodulator-only and 675.1 (95% CI 130.4 – 1219.9) in patients newly treated with immunosuppressant-only. Conclusions There was no increased incidence of malignancy overall or by type in patients with multiple sclerosis compared neither with the general population nor in relation to disease-modifying therapy.

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