The rate of disease reactivation after the cessation of therapies is different among patients with multiple sclerosis (MS), according to a new study published in Neurology. The peak of relapse activity occurs after 1 to 10 months. 

“These results suggest that untreated intervals should be minimized after stopping anti-trafficking therapies (natalizumab and fingolimod),” the authors of the study wrote. 

To evaluate the relapse rate of disease activity after stopping disease-modifying treatments in patients with MS, a team of researchers led by Tomas Kalincik, MD, PhD, from the Melbourne MS Centre, Department of Neurology, Royal Melbourne Hospital in Australia conducted a retrospective cohort study using data from 2 large observational MS registries, MSBase and Observatoire Français de la Sclérose en Plaques (OFSEP).

Continue Reading

The researchers analyzed data from patients with relapsing-remitting MS who had stopped taking a disease-modifying treatment and were followed for a year. The cohort consisted of 14,213 patients who had 18,029 discontinuation episodes involving 7 therapies. 

Read more about disease-modifying therapies for MS

The researchers found that the annualized relapse rate started to increase 2 months after the cessation of natalizumab. The initiation of another therapy within 2 to 4 months reduced the magnitude of the reactivation of the disease. 

Following fingolimod discontinuation, the relapse rate increased overall but stabilized faster in patients who started a new therapy within 1 to 2 months.

The magnitude of disease reactivation for other therapies was lower and was reduced even more when another therapy was started 1 to 10 months later. 

The researchers identified a higher relapse rate in the year before treatment cessation, female sex, younger age, and a higher Expanded Disability Status Scale (EDSS) score as predictors of relapse. The initiation of another therapy reduced the risk of relapse as well as the accumulation of disability.


Roos I, Malpas C, Leray E, et al; MSBase; OFSEP. Disease reactivation after cessation of disease-modifying therapy in patients with relapsing-remitting multiple sclerosis. Neurology. Published online August 17, 2022. doi:10.1212/WNL.0000000000201029