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	#Post#: 4924--------------------------------------------------
	(ECTRIMS preliminary abstract) Defining optimal profiles for tre
	atment discontinuation in older MS patients
	By: agate Date: September 11, 2025, 1:30 am
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	Abstracts from the upcoming ECTRIMS conference are being
	released in advance. They probably aren't in their final format
	and so it would be best to wait until the actual conference has
	taken place before posting any of them. However, just to try one
	out, here is one from Scientific Session 2: Treatment in the
	Elderly. I have omitted all but the first author's name, the
	authors' affiliations, and their Disclosure
	of Interest statements. The authors are from Spain, Italy,
	Netherlands, the UK, and Australia.
	[quote][font=sage peak]Defining Optimal Profiles for Treatment
	Discontinuation in Older MS Patients[/font]
	[font=sage peak]
	Ren� Carvajal et al.[/font]
	Introduction:
	The prevalence of aging people with MS (PwMS) is increasing.
	Disease modifying therapy (DMT) effectiveness declines with age,
	while the risk of adverse events increases. Discontinuing DMT is
	an option, but selection of appropriate candidates remains
	unclear.
	Objectives/Aims:
	To characterize DMT discontinuation in PwMS aged ⩾50 and
	compare inflammatory and neurodegenerative outcomes with those
	who continue treatment.
	Methods:
	Retrospective study of a prospectively collected cohort (since
	1994) at a single centre in Catalonia. PwMS aged ⩾50 on
	DMT with ⩾6 months of exposure were included. DMTs were
	categorized as first-line, anti-trafficking, or anti-CD20
	therapies. Discontinuation was defined as ceasing therapy for
	⩾6 months, with incidence and primary causes recorded.
	Treatment continuation episodes based on key baselines features
	were established using propensity score matching (1:6 ratio). We
	assessed outcomes�including inflammatory activity (relapses or
	new/contrast-enhancing lesions) and 12-week confirmed disability
	worsening (CDW)�using proportional hazards models, and conducted
	subgroup analyses.
	Results:
	Among 563 older PwMS, 113 (20%) discontinued therapy (median
	[IQR] age 58 [54-65] yrs; 74% female; median disease duration 21
	yrs; median EDSS 5.5; median time free of inflammatory activity
	4.5 yrs). Among these, 82 (73%) stopped first-line therapies
	(mainly due to tolerability issues), 26 (23%) anti-CD20, and 5
	(4%) anti-trafficking (both primarily due to safety
	concerns/infections).
	Matching yielded 725 patients (109 discontinuation, 616
	continuation episodes) with median follow-ups of 5.0 yrs (IQR
	3.2�8.9) and 4.2 yrs (IQR 2.1�7.4), respectively. After
	baseline, in the discontinuation group, 19.2% experienced
	relapses versus 14.1% in the continuation group (p=0.6), while
	MRI activity was observed in 40.9% versus 17.9%, respectively
	(p<0.005). Discontinuation increased inflammatory risk for
	first-line (HR=2.18, 95%CI: 1.50�3.16; p<0.001) and
	anti‑trafficking (HR=24.9, 95%CI: 1.99�311; p=0.013), but
	not for anti‑CD20 (HR=2.18, 95%CI: 0.78�6.08; p=0.14). In
	subgroup analyses, discontinuation increased inflammatory risk
	in all groups except patients >60, those on anti‑CD20, and
	those treated >10 years. Discontinuation was not associated with
	increased CDW risk overall (HR= 0.99, 95%CI: 0.56�1.72; p >0.9)
	or in subgroup analyses.
	Conclusion:
	DMT discontinuation in older PwMS appears feasible for those
	over 60, on anti‑CD20, and with over 10 years of
	treatment, and was not linked to disability progression.
	[/quote]
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