Is It Safe for Older People With MS To Stop Taking a DMT? | MyMSTeam

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Is It Safe for Older People With MS To Stop Taking a DMT?

Medically reviewed by Kelsey Stalvey, PharmD
Posted on June 2, 2023

With age comes wisdom, and if you’re lucky, it may also come with fewer multiple sclerosis (MS) relapses. If you’re an older person who’s gone years without an MS flare, it’s common to question whether you still need to be taking a disease-modifying therapy (DMT). This type of treatment aims to slow down the course of a disease instead of just addressing its symptoms.

Every individual with MS is different. The decision to stop a DMT can be complex, and it’s one you should make with your MS specialist. Here’s an overview of current guidelines, potential pros and cons, and factors to discuss with your doctor if you’re thinking of discontinuing your DMT for MS.

What Do Guidelines Say About Stopping DMTs for Older People?

There’s a lack of consensus among MS clinicians about when it’s safe to discontinue DMTs.

Based on guidelines from the Consortium of Multiple Sclerosis Centers, individuals with relapsing MS and clinically isolated syndrome (CIS) who are older than 60 and have a prolonged inactive period of the disease, with no relapses and no evidence of new lesions on MRI, may consider discontinuing DMTs. CIS is the first episode of neurological symptoms that could be a sign of the beginning of the disease.

For people over age 60 with secondary progressive MS (SPMS), doctors could consider stopping a DMT if it’s not proven effective in slowing progression, if side effects from a DMT outweigh the benefits, or if there’s significant disability associated with advanced neurodegeneration (damage and loss of nerve cells in the brain or other parts of the nervous system).

Still, it’s a controversial topic, and the decision is highly individualized based on each person’s specific condition. Remember that for people with MS in general, discontinuing DMTs is associated with a higher relapse rate.

Research is underway to determine more details about who will benefit from remaining on treatment and who can safely stop.

Pros and Cons of Discontinuing DMTs for Older Adults

Research has provided some important facts to keep in mind for older people considering whether it’s time to stop taking a DMT.

Potential reasons to consider stopping a DMT:

  • DMTs may become less effective for older people. It’s difficult to be certain because clinical trials don’t usually include those over 55.
  • You may develop more side effects from DMTs as you age.
  • Older people with MS are likely to be taking multiple medications for various health conditions, which can lead to higher costs, worse outcomes, more drug interactions, and not sticking with therapy.

On the other hand, as you age, you lose your ability to recover from relapses. Researchers think that older people tend to have fewer MS relapses because the efficiency of the immune system declines over time. However, even one relapse at an older age is believed to significantly increase the risk for worsened disability and progressive disease. This is often called “relapse recovery,” and the ability to perform this well declines with age. From this perspective, it becomes even more important to lower the risk of relapses in older adults.

Factors To Discuss With Your Doctor

It’s important to work together with your neurologist to decide whether to stop taking a DMT. Because there are no firm rules about who should continue taking a DMT and who should stop, it’s largely up to people with MS and their doctors to determine what’s best.

Here are five factors you and your doctor might consider when deciding whether you should discontinue your DMT.

1. Your Age

How old you are should play a role in your decision. Some research from the journal Multiple Sclerosis has found that people who are older when they stop their DMT might be less likely to have disease relapses or disease activity.

2. The Stability of Your MS

Your doctor might describe your MS as stable or inactive if you aren’t having MRI changes, relapses, or worsening disability. One study suggested that people older than 45 whose MS has been stable for four or more years before stopping DMTs might have a lower risk of disease relapse. If your MS has been stable for years, you might consider stopping your MS treatment.

3. The Type of MS You Have

People with secondary progressive MS (SPMS) might have better outcomes when stopping a DMT than people with relapsing-remitting MS (RRMS). A study in the International Journal of MS Care found that people aged 70 or older with stable secondary progressive MS (SPMS) for at least two years had an 88 percent chance of experiencing no disease recurrences in the next one to two years after discontinuing their DMT. The same study found people with RRMS had only a 41 percent chance of not having a disease recurrence. The type of MS you have can make a big difference in what might happen after stopping a DMT.

4. How Your MS Has Progressed

Many people with MS start with RRMS and later develop SPMS. As per recommendations from the American Academy of Neurology, for people with SPMS whose disease has been stable and who have not been able to walk for two or more years, the benefits of continuing a DMT may be limited. If the benefits are limited, they might not outweigh the risks, costs, and side effects anymore, and you might consider stopping a DMT.

5. The Medication Side Effects You Experience

Medication side effects can range from mild to miserable. A study from the journal Multiple Sclerosis and Related Disorders cited that 33 percent of people who decided to stop their DMT did so because of medication side effects. If you’re experiencing bothersome side effects from your DMT, or you are worried about harmful interactions between the different medications you take, you and your doctor will need to carefully weigh the risks and benefits of continuing the DMT. Your doctor might recommend you try another DMT, take a drug holiday, or stop completely.

Making a Shared Decision

If you’re considering stopping your DMT, ask your neurologist about your disease activity. Review past MRI results. Talk about your symptoms, your Expanded Disability Status Scale (EDSS) score, and medication side effects. After considering these factors, you and your doctor might decide together to stop your DMT. If your doctor doesn’t think it’s the right time to stop, make a follow-up plan. Ask what signs you should look for in the future that might mean it’s time to stop your DMT. No matter what, the final decision is yours.

If you and your neurologist decide it’s time to stop your DMT, it’s important to continue getting regular follow-ups and MRIs to make sure your MS remains inactive.

If you decide to stop taking a DMT for MS, it doesn’t have to be a permanent decision. If you stop the medication and start experiencing more disease activity or relapses, you can take the medication again or explore other treatment options. Your MS specialist is a valuable source of information and support. They can assess your situation, evaluate how well the previous medication worked for you, and help you find the best treatment plan for your needs. Talking regularly with your MS specialist is vital to make sure any changes in your treatment plan are personalized to you and help manage your MS effectively.

Talk With Others Who Understand

MyMSTeam is the social network for people with multiple sclerosis and their loved ones. On MyMSTeam, more than 199,000 members come together to ask questions, give advice, and share their stories with others who understand life with multiple sclerosis.

Are you considering stopping your DMT? What’s important to you as you make this decision? Share your experience in the comments below, or start a conversation by posting on your Activities page.

References
  1. CMSC Practical Guidelines for the Selection of Disease Modifying Therapies in MS — Consortium of Multiple Sclerosis Centers
  2. Impact of Age on Multiple Sclerosis Disease Activity and Progression — Current Neurology and Neuroscience Reports
  3. Multi-Drug Use Among Patients With Multiple Sclerosis: A Cross-Sectional Study of Associations to Clinicodemographic Factors — Scientific Reports
  4. Disease-Modifying Therapies in Multiple Sclerosis: Overview and Treatment Considerations — Federal Practitioner
  5. Practice Guideline Recommendations Summary: Disease-Modifying Therapies for Adults With Multiple Sclerosis — Neurology
  6. The Dilemma of When To Stop Disease-Modifying Therapy in Multiple Sclerosis — International Journal of MS Care
  7. Can People in Later Stages of MS Stop Taking Disease-Modifying Therapies? (The DISCOMS Trial) — Patient-Centered Outcomes Research Institute
  8. Discontinuation of First-Line Disease-Modifying Therapy in Relapse Onset Multiple Sclerosis — Multiple Sclerosis and Related Disorders
  9. NEDA (No Evidence of Disease Activity) — Multiple Sclerosis Trust
  10. Relapsing-Remitting MS (RRMS) — National Multiple Sclerosis Society
  11. Discontinuation of Disease-Modifying Therapies in Multiple Sclerosis — Clinical Outcome and Prognostic Factors — Multiple Sclerosis
  12. Stopping Disease-Modifying Therapy in Nonrelapsing Multiple Sclerosis — International Journal of MS Care
  13. Disease Courses — National Multiple Sclerosis Society
  14. Drug Interactions: What You Should Know — U.S. Food and Drug Administration
  15. Should You Take a Drug Holiday? — Harvard Health Publishing

Posted on June 2, 2023
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Kelsey Stalvey, PharmD received her Doctor of Pharmacy from Pacific University School of Pharmacy in Portland, Oregon, and went on to complete a one-year postgraduate residency at Sarasota Memorial Hospital in Sarasota, Florida. Learn more about her here.
Kelly Crumrin is a senior editor at MyHealthTeam and leads the creation of content that educates and empowers people with chronic illnesses. Learn more about her here.
Lauren Jansen, M.D., MPH earned a Bachelor of Science in chemistry from the University of Connecticut in 2012, a Doctor of Medicine from Albany Medical College in 2016, and a Master of Public Health from University of Massachusetts Amherst in 2021. Learn more about her here.

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