Contributions
Abstract: P1225
Type: Poster
Abstract Category: Therapy - disease modifying - Long-term treatment monitoring
Background: Multiple sclerosis (MS) is a chronic inflammatory neurological disease requiring long term disease-modifying treatment (DMT). Disease activity declines over time and prolonged periods of disease quiescence may prompt DMT discontinuation. However, there are no recommendations available when to discontinue DMT. The aim of this study was to investigate the clinical outcome after DMT discontinuation in relapsing-remitting MS (RRMS) patients and identify factors predictive of outcome.
Methods: In this retrospective, observational study, we screened the Innsbruck MS database for RRMS patients who had received DMT for a minimum period of 12 months, discontinued DMT and had a follow up of at least 2 years available. Patients who restarted DMT within 6 months or were discontinued due to conversion to secondary progressive MS were excluded. Hazard ratios (HRs) with 95% confidence intervals (CIs) with regard to relapse and disability progression (defined as a confirmed EDSS increase of 0.5) after DMT discontinuation were calculated from Cox regression models including age, disease duration and time of DMT intake.
Results: A total of 230 patients (70.4% female) were included. Mean age at discontinuation was 37.9 years (SD 16.1), mean disease duration 6.2 years (SD 8.1), mean time of DMT intake 3.3 years (SD 3.7) and mean time of follow up 5.0 years (SD 1.2). DMTs included interferon beta preparations (67.0%), glatirameracetate (15.2%) or other drugs (17.8%). Reasons for DMT discontinuation were safety/tolerance issues (45.7%), personal reasons (23.4%), stable disease course (26.5%) or pregnancy (4.4%). Median EDSS at discontinuation was 2.0 (range 0.0 - 5.5). During follow up, relapses occurred in 102 (44.3%) and disability progression in 50 patients (21.7%). Patients aged > 45 years taking DMT for > 4 years before discontinuation without a relapse had a cumulative HR of 0.06 (CI 0.01 - 0.46, p< 0.001) to suffer a relapse and a cumulative HR of 0.65 (CI 0.18 - 2.34, ns) for disability progression.
Conclusions: The outcome of discontinuation of DMT in RRMS depends on individual factors. While freedom from subsequent disease activity is impossible to predict, there seems to be a subset of patients (age > 45 years, DMT intake > 4 years without evidence of clinical disease activity) having a high likelihood of remaining stable after DMT discontinuation. However, clinical monitoring for recurrent disease activity is mandatory in those discontinuing treatment.
Disclosure: G Bsteh, J Feige, R Ehling, H Hegen, M Auer, F Di Pauli, F Deisenhammer and T Berger: nothing to disclose.
Abstract: P1225
Type: Poster
Abstract Category: Therapy - disease modifying - Long-term treatment monitoring
Background: Multiple sclerosis (MS) is a chronic inflammatory neurological disease requiring long term disease-modifying treatment (DMT). Disease activity declines over time and prolonged periods of disease quiescence may prompt DMT discontinuation. However, there are no recommendations available when to discontinue DMT. The aim of this study was to investigate the clinical outcome after DMT discontinuation in relapsing-remitting MS (RRMS) patients and identify factors predictive of outcome.
Methods: In this retrospective, observational study, we screened the Innsbruck MS database for RRMS patients who had received DMT for a minimum period of 12 months, discontinued DMT and had a follow up of at least 2 years available. Patients who restarted DMT within 6 months or were discontinued due to conversion to secondary progressive MS were excluded. Hazard ratios (HRs) with 95% confidence intervals (CIs) with regard to relapse and disability progression (defined as a confirmed EDSS increase of 0.5) after DMT discontinuation were calculated from Cox regression models including age, disease duration and time of DMT intake.
Results: A total of 230 patients (70.4% female) were included. Mean age at discontinuation was 37.9 years (SD 16.1), mean disease duration 6.2 years (SD 8.1), mean time of DMT intake 3.3 years (SD 3.7) and mean time of follow up 5.0 years (SD 1.2). DMTs included interferon beta preparations (67.0%), glatirameracetate (15.2%) or other drugs (17.8%). Reasons for DMT discontinuation were safety/tolerance issues (45.7%), personal reasons (23.4%), stable disease course (26.5%) or pregnancy (4.4%). Median EDSS at discontinuation was 2.0 (range 0.0 - 5.5). During follow up, relapses occurred in 102 (44.3%) and disability progression in 50 patients (21.7%). Patients aged > 45 years taking DMT for > 4 years before discontinuation without a relapse had a cumulative HR of 0.06 (CI 0.01 - 0.46, p< 0.001) to suffer a relapse and a cumulative HR of 0.65 (CI 0.18 - 2.34, ns) for disability progression.
Conclusions: The outcome of discontinuation of DMT in RRMS depends on individual factors. While freedom from subsequent disease activity is impossible to predict, there seems to be a subset of patients (age > 45 years, DMT intake > 4 years without evidence of clinical disease activity) having a high likelihood of remaining stable after DMT discontinuation. However, clinical monitoring for recurrent disease activity is mandatory in those discontinuing treatment.
Disclosure: G Bsteh, J Feige, R Ehling, H Hegen, M Auer, F Di Pauli, F Deisenhammer and T Berger: nothing to disclose.