When Can We Consider Treatment Discontinuation in Stable Multiple Sclerosis?

For patients with stable multiple sclerosis (MS), discontinuing or de-escalating disease-modifying therapy could have benefits, but prospective data on relapse risk are limited. One recent study showed that disease activity was uncommon for patients with stable disease who were at least 55 years old (NEJM JW Neurol Jul 28 2023 and Lancet Neurol 2023; 22:568).

To test treatment discontinuation in a wider age range, researchers randomized 89 patients at 14 centers aged 18 years or older (median, 54 years), who had no relapses or new MRI lesions in the prior 5 years on first-line therapies, to continue or discontinue therapy. The primary outcome was clinical relapse or substantial radiologic activity (at least 3 new T2 lesions or 2 new gadolini…