Treatment discontinuation in older patients with multiple sclerosis

Objective: To examine disease activity in older people with multiple sclerosis (pwMS) following discontinuation of disease-modifying treatments (DMTs). Methods: PwMS aged 60 years or older who discontinued DMTs were included. Data on clinical and demographic factors, as well as new or gadolinium-enhancing lesions on magnetic resonance imaging (MRI) during the final year on DMT and after discontinuation, were analysed. McNemar's test was used to assess intra-patient MRI activity differences before and after discontinuation. Cox regression evaluated factors influencing MRI activity post-discontinuation. Results: We included 114 pwMS (78.1 % female) from 3 Italian MS centres who discontinued a DMT. The mean age at disease onset was 42.4 years (SD: 11.74), and at DMT discontinuation, 65.7 years (SD: 3.84). Median EDSS was 5.5 (IQR: 2.5–6.0). First-line DMTs were discontinued in 105 participants. No significant changes in MRI activity before and after discontinuation were observed (p = 0.5). Pre-discontinuation MRI activity was the only factor associated with post-discontinuation activity (p = 0.021). Conclusions: In pwMS aged over 60 years, discontinuing DMTs does not increase the risk of MRI-detected disease activity. Discontinuation may be a viable option for this population.