Discontinuation of Multiple Sclerosis Medication Leads to Increased Disease Activity

Nonadherence or discontinuation of multiple sclerosis (MS) medication can increase the likelihood of the return of disease activity, according to findings presented at the American Academy of Neurology Annual Meeting held April 18 to 25 in Washington, DC.

Researchers from NYU Langone Medical Center and the New York University School of Medicine examined 181 patients from the MS Base Registry — a global observational database – in order to determine the MS relapse rate and disability progression rates in patients who stopped taking their prescribed disease-modifying therapies. The patients were included in the study if they were aged 40 years or older, had experienced no relapses, and reported stable disability progression for at least 5 years, and had been taking medication for at least 3 years. The minimum follow up period used for this observation was 3 years.

About a quarter of the patients (24 percent) experienced a clinician reported relapse after discontinuing their medication. A third of patients sustained 3 month disability progression, while 10.6 percent of patients experienced both relapses and disability progression. The researchers reported 42 percent of patients who restarted medication after a median period of 22 months. When patients restarted their medications, the researchers determined there was a 59 percent risk reduction of disability progression.

“Despite long periods of disease stability while taking medication, we found a large minority of patients who stopped experienced relapses or disability progression,” lead study author Ilya Kister, MD, explained in a press release. “We need to identify situations when it is safe for patients with MS to stop taking these medications.”

The press release continued by noting that MS patients stop taking their disease modifying medications for a variety of reasons. Some contributing factors to medication non adherence or discontinuation include side effects, perceptions the patient is not feeling better, the patient still experiencing exacerbations, or for insurance purposes.

“Decisions regarding stopping disease modifying therapy may have implications for short and long term prognosis,” continued Kister. “We know a lot about what happens when therapy is started, but we know very little about what happens when therapy is stopped.”

In the future, the research team hopes to either conduct themselves or see others perform experiments such as randomized trials of discontinuations of disease-modifying therapy to provide more data for when exactly it may be safe for MS patients to halt their medications.