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Research paper
Discontinuing disease-modifying therapy in MS after a prolonged relapse-free period: a propensity score-matched study
  1. Ilya Kister1,
  2. Tim Spelman2,3,
  3. Raed Alroughani4,
  4. Jeannette Lechner-Scott5,
  5. Pierre Duquette6,
  6. Francois Grand'Maison7,
  7. Mark Slee8,
  8. Alessandra Lugaresi9,
  9. Michael Barnett10,
  10. Pierre Grammond11,
  11. Gerardo Iuliano12,
  12. Raymond Hupperts13,
  13. Eugenio Pucci14,
  14. Maria Trojano15,
  15. Helmut Butzkueven2,3
  16. on behalf of the MSBase Study Group
  1. 1Department of Neurology, NYU Multiple Sclerosis Care Center, NYU School of Medicine, New York, New York, USA
  2. 2Department of Neurology, Royal Melbourne Hospital, Parkville, Victoria, Australia
  3. 3Department of Medicine (RMH), The University of Melbourne, Parkville, Victoria, Australia
  4. 4Amiri Hospital, Kuwait City, Kuwait
  5. 5John Hunter Hospital, Newcastle, New South Wales, Australia
  6. 6Hôpital Notre Dame, Montreal, Quebec, Canada
  7. 7Neuro Rive-Sud, Hôpital Charles LeMoyne, Québec, Quebec, Canada
  8. 8Flinders University and Flinders Medical Centre, Adelaide, South Australia, Australia
  9. 9Department of Biomedical and NeuroMotor Sciences (DIBINEM), Mater Studiorum - Université di Bologna, Italy and IRCCS Istituto delle Scienze Neurologiche – “UOSI Riabilitazione Sclerosi Multipla” – Bologna, Italy
  10. 10Brain and Mind Research Institute, University of Sydney, Sydney, New South Wales, Australia
  11. 11Centre de réadaptation déficience physique Chaudière-Appalache, Levis, Quebec, Canada
  12. 12Ospedali Riuniti di Salerno, Salerno, Italy
  13. 13Orbis Medical Centre, Sittard-Geleen, The Netherlands
  14. 14UOC Neurologia, ASUR Marche, Area Vasta 3, Macerata, Italy
  15. 15Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari, Bari, Italy
  1. Correspondence to Dr Ilya Kister, Department of Neurology, NYU Multiple Sclerosis Care Center, NYU School of Medicine, 240 East 38th St, New York, NY 10026, USA; ilya.kister{at}nyumc.org

Abstract

Background Discontinuation of injectable disease-modifying therapy (DMT) for multiple sclerosis (MS) after a long period of relapse freedom is frequently considered, but data on post-cessation disease course are lacking.

Objectives (1) To compare time to first relapse and disability progression among ‘DMT stoppers’ and propensity-score matched ‘DMT stayers’ in the MSBase Registry; (2) To identify predictors of time to first relapse and disability progression in DMT stoppers.

Methods Inclusion criteria for DMT stoppers were: age ≥18 years; no relapses for ≥5 years at DMT discontinuation; follow-up for ≥3 years after stopping DMT; not restarting DMT for ≥3 months after discontinuation. DMT stayers were required to have no relapses for ≥5 years at baseline, and were propensity-score matched to stoppers for age, sex, disability (Expanded Disability Status Score), disease duration and time on treatment. Relapse and disability progression events in matched stoppers and stayers were compared using a marginal Cox model. Predictors of first relapse and disability progression among DMT stoppers were investigated using a Cox proportional hazards model.

Results Time to first relapse among 485 DMT stoppers and 854 stayers was similar (adjusted HR, aHR=1.07, 95% CI 0.84 to 1.37; p=0.584), while time to confirmed disability progression was significantly shorter among DMT stoppers than stayers (aHR=1.47, 95% CI 1.18 to 1.84, p=0.001). The difference in hazards of progression was due mainly to patients who had not experienced disability progression in the prebaseline treatment period.

Conclusions Patients with MS who discontinued injectable DMT after a long period of relapse freedom had a similar relapse rate as propensity score-matched patients who continued on DMT, but higher hazard for disability progression.

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