Discontinuation of disease-modifying treatment (DMT) leads to a progression of multiple sclerosis (MS) and a worsening in Expanded Disability Status Scale (EDSS) scores, according to a study published in Multiple Sclerosis and Related Disorders.

Patients with relapsing-remitting MS were followed for 5 years during the study and DMT adherence and outcomes were monitored. Over the 5 years, the treatment adherence rate was 82.5%. The primary reasons for discontinuation were burnout from the chronic treatment process, a feeling of remission and no longer needing the treatment, and intolerance of the drug’s adverse effects.

The study also found that all 47 patients who discontinued DMT later restarted treatment. The primary reason for this was a worsening of symptoms (n=37) while they shared patient and physician decision-making accounted for the remaining patients (n=10). 


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“In other words, if the treatment process [can] be more facilitated and patients get informed of the possibility of disease recurrence following the cessation of treatment, leaving treatments can be prevented to a large extent,” the authors said.

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The mean EDSS scores showed an increase from baseline after 5 years for all patients rising from 0.78±0.90 to 1.04±1.11. While the mean scores increased over the 5-year time period, EDSS scores were significantly higher in the group of patients without appropriate adherence (P <.001). Patients with adherence had a mean EDSS at year 5 of 0.92±1.09 compared to 1.76±1.17 in the nonadherent group.

Participants who were married and/or had levels of education equal to or above high school graduation had higher rates of adherence than those who were single and/or did not complete high school. The type of DMT also appeared to affect adherence with patients receiving glatiramer acetate, fingolimod, and rituximab having higher adherence rates than those who received dimethyl fumarate or interferon beta-1a.

A total of 288 new patients with relapsing-remitting MS were recruited for the study with the majority being female, married, and unemployed. Sixty-eight patients changed DMTs during the trial due to intolerance or reaction to the drug. Additionally, 20 participants became pregnant and were monitored separately during the trial.

Reference

Bawand R, Ghiasian M, Fathoallahi N, Moradi A. Effects of disease-modifying treatments discontinuation in patients with relapsing-remitting multiple sclerosis: a 5 year prospective cohort study. Mult Scler Relat Disord. 2022;63:103857. doi:10.1016/j.msard.2022.103857