Discontinuation of disease modifying treatments in middle aged multiple sclerosis patients: First line drugs vs natalizumab
2017 (English)In: Multiple Sclerosis and Related Disorders, ISSN 2211-0348, E-ISSN 2211-0356, Vol. 12, 82-87 p., S2211-0348(17)30010-XArticle in journal (Refereed) Published
BACKGROUND: Several disease-modifying drugs (DMD) are available for the treatment of MS, and most patients with relapsing-remitting disease are currently treated. Data on when and how DMD treatment can be safely discontinued are scarce.
METHODS: Fifteen MS patients, treated with natalizumab for >5 years without clinical and radiological signs of inflammatory disease activity, suspended treatment and were monitored with MRI examinations and clinical follow-up to determine recurrence of disease activity. This group was compared with a retrospectively analysed cohort comprising 55 MS patients treated with first-line DMDs discontinuing therapy in the time period of 1998-2015 after an analogous stable course.
RESULTS: Natalizumab discontinuers were followed for on average 19 months, and follow-up data for 56 months were available for first-line DMD quitters. Two-thirds of natalizumab treated patients experienced recurrent inflammatory disease activity, and one third had recurrence of rebound character. In contrast, 35% of first-line DMD quitters had mild recurrent disease activity, and no one exhibited rebound.
CONCLUSIONS: Withdrawal of a first-line DMD after prolonged treatment in middle-aged MS patients with stable disease appears to be relatively safe, while natalizumab withdrawal in a similar group of patients cannot be safely done without starting alternative therapy.
Place, publisher, year, edition, pages
2017. Vol. 12, 82-87 p., S2211-0348(17)30010-X
Multiple sclerosis, Natalizumab discontinuation, Rebound, Treatment discontinuation
IdentifiersURN: urn:nbn:se:uu:diva-317425DOI: 10.1016/j.msard.2017.01.009PubMedID: 28283113OAI: oai:DiVA.org:uu-317425DiVA: diva2:1081559