Multiple Sclerosis Relapses After Stopping Disease-Modifying Therapy

Multiple sclerosis (MS) disease rebound — defined as more-severe disease than before treatment — has been described with discontinuation of natalizumab and of S1P inhibitors like fingolimod. To evaluate rebound further, investigators analyzed disease-modifying therapy (DMT) discontinuations in more than 14,000 patients in this retrospective, international, observational registry study.

After natalizumab, median time to the next therapy was 2 months. Relapses increased between months 2 and 4 for both those who did and those who did not start a new therapy. Annualized relapse rates (ARR) peaked at 4 to 6 months after natalizumab discontinuation (ARR 0.98; 95% confidence interval, 0.89–1.08). For fingolimod, stopping was due to lack of efficacy…