Contributions
Abstract: P744
Type: Poster
Abstract Category: Therapy - disease modifying - 28 Long-term treatment monitoring
Background: Disease modifying therapies (DMTs) in multiple sclerosis (MS) have robust inflammatory effects. As the immune system becomes less functional in older patients, it is unclear whether continued immunomodulation remains beneficial. There is insufficient data regarding the necessary duration of DMT or impact of discontinuation to guide clinicians. This study evaluates outcomes of DMT discontinuation in patients with MS over age 60 in real world settings.
Methods: Patients were identified from our MS specialty clinics who were over age 60, on DMT for >2 years, with corresponding clinician and patient-reported outcomes. Cox proportion hazards regression modeled the association between time to restart DMT and covariates of disease course, gender, disease duration, time on DMT, number of DMTs, DMT at discontinuation, provider vs patient initiated, and walking ability at discontinuation. Pre and post discontinuation comparisons of MS Performance Scales (MSPS), Timed 25 Foot Walk and Patient Health Questionnaire-9 (PHQ9) were analyzed using linear mixed models.
Results: 644 patient with confirmed MS diagnosis and initial DMT use before age 60 were included, with 194 (30.1%) patients discontinuing. There were 2 relapses and little MRI activity in discontinuers, with 10.3% of patients restarting DMT. The only significant predictor of restarting was provider vs patient initiated with provider-initiated discontinuers less likely to restart DMT (HR 0.37, 95% CI 0.136 to 0.987; p=0.047). Estimated survival curves show that 87.6% of patients who stopped DMT after age 60 remain off DMT at 4 years. For outcomes in the discontinuation group, on average, relapse-remitting patients had a lower MSPS by 2.3 compared to primary progressive (95% CI -4.095 to -0.473; p=0.014). Provider-initiated discontinuation was associated with lower MSPS score, with a difference of 2.3 (95% CI -3.6 to -1.0; p=0.001). There were no significant differences in Timed 25 Foot Walk or PHQ9 pre and post discontinuation.
Discussion: Most patients over age 60 who discontinued DMT after at least 2 years treatment, remained off DMT. Patients are more likely to remain off therapy when the provider initiated discontinuation. MSPS improved in discontinuers with RR disease and when providers initiated discontinuation. No other significant differences in outcomes were seen. This study provides real world data that may help guide clinicians and patients considering discontinuing DMT.
Disclosure:
Le Hua has received honoraria for speaking, consulting and advisory board activities from Biogen, Teva, Genzyme, Genentech, Novartis, EMD Serono, and TG Therapeutics.
Tracey Fan has nothing to disclose.
Devon Conway has received research support paid to his institution by Novartis.
Nicolas Thompson has received salary support from Novartis for research outside of submitted work.
Tyler Kinzy has nothing to disclose.
Abstract: P744
Type: Poster
Abstract Category: Therapy - disease modifying - 28 Long-term treatment monitoring
Background: Disease modifying therapies (DMTs) in multiple sclerosis (MS) have robust inflammatory effects. As the immune system becomes less functional in older patients, it is unclear whether continued immunomodulation remains beneficial. There is insufficient data regarding the necessary duration of DMT or impact of discontinuation to guide clinicians. This study evaluates outcomes of DMT discontinuation in patients with MS over age 60 in real world settings.
Methods: Patients were identified from our MS specialty clinics who were over age 60, on DMT for >2 years, with corresponding clinician and patient-reported outcomes. Cox proportion hazards regression modeled the association between time to restart DMT and covariates of disease course, gender, disease duration, time on DMT, number of DMTs, DMT at discontinuation, provider vs patient initiated, and walking ability at discontinuation. Pre and post discontinuation comparisons of MS Performance Scales (MSPS), Timed 25 Foot Walk and Patient Health Questionnaire-9 (PHQ9) were analyzed using linear mixed models.
Results: 644 patient with confirmed MS diagnosis and initial DMT use before age 60 were included, with 194 (30.1%) patients discontinuing. There were 2 relapses and little MRI activity in discontinuers, with 10.3% of patients restarting DMT. The only significant predictor of restarting was provider vs patient initiated with provider-initiated discontinuers less likely to restart DMT (HR 0.37, 95% CI 0.136 to 0.987; p=0.047). Estimated survival curves show that 87.6% of patients who stopped DMT after age 60 remain off DMT at 4 years. For outcomes in the discontinuation group, on average, relapse-remitting patients had a lower MSPS by 2.3 compared to primary progressive (95% CI -4.095 to -0.473; p=0.014). Provider-initiated discontinuation was associated with lower MSPS score, with a difference of 2.3 (95% CI -3.6 to -1.0; p=0.001). There were no significant differences in Timed 25 Foot Walk or PHQ9 pre and post discontinuation.
Discussion: Most patients over age 60 who discontinued DMT after at least 2 years treatment, remained off DMT. Patients are more likely to remain off therapy when the provider initiated discontinuation. MSPS improved in discontinuers with RR disease and when providers initiated discontinuation. No other significant differences in outcomes were seen. This study provides real world data that may help guide clinicians and patients considering discontinuing DMT.
Disclosure:
Le Hua has received honoraria for speaking, consulting and advisory board activities from Biogen, Teva, Genzyme, Genentech, Novartis, EMD Serono, and TG Therapeutics.
Tracey Fan has nothing to disclose.
Devon Conway has received research support paid to his institution by Novartis.
Nicolas Thompson has received salary support from Novartis for research outside of submitted work.
Tyler Kinzy has nothing to disclose.