What to consider if you are considering discontiuing multiple sclerosis disease modifying therapy

In the last 10 years there have been increasing studies and data to help patients to decide if they do want to come off their disease modifying therapies if:

• They have the relapsing remitting form of multiple sclerosis

• They are older than 55 years

• It has been many years since their last attack

• They have not had any MRI goression for many years.

There is no way to know for sure if your relapsing remitting multiple sclerosis will cause another attack. The oldest patient I have known that had a new attack was 73 when it happened. However, the older one is and the longer it has been since there has been evidence of disease progression, the less likely a new attack is. If you are not sure, the most cautious approach is to stay on medication. However it is an individual decision that can be considered on a case by case basis.

One of the better studies to address the risk so far was "Risk of new disease activity in patients with multiple sclerosis who continue or discontinue disease-modifying therapies (DISCOMS): a multicentre, randomised, single-blind, phase 4, non-inferiority trial" Published in Lancet in 2023. It did not see a difference between new attack rate for patients on therapy or off therapy who were older than 55, had no relapse within the past 5 years or new MRI lesion in the past 3 years.

There are more studies ongoing and this may not be the most up to date resource.