Contributions
Abstract: P1230
Type: Poster Sessions
Abstract Category: Therapy - Long-term treatment monitoring
Introduction: Current immunomodulatory disease modifying therapies (DMTs) may no longer benefit patients over age 60, due to little inflammatory activity presence or having already reached significant disability, leading clinicians and patients to consider stopping DMT. Our prior study demonstrated that discontinuing DMT can be successful in most patients over age 60.
Objective: This study focuses on changes in outcomes (EQ-5D, MSPS, T25FW, PHQ-9, new T2 or GdE lesions) over time between those who continued vs discontinued DMT.
Methods: Patients were previously identified from our MS clinics who were >60, on DMT for >2 years, with corresponding clinician and patient-reported outcomes (PRO). To compare how outcomes changed over time among treatment groups (continuers, discontinuers before discontinuation (DBD), and discontinuers after discontinuation (DAD)), we created separate mixed-effects linear regression models. We included an interaction term between the time and treatment group to study the trajectory of the outcome. Independent variables were time from age 60 and treatment group, with the following covariates: age at diagnosis, gender, MS course at baseline, time on DMT, baseline DMT and ambulation status at age 60. Among the final models, we made pairwise comparisons among the three treatment groups.
Results: 178 out of 600 patients discontinued DMT. Only the EQ-5D mixed-effects linear regression model with the interaction term was statistically significant (p-value = 0.043). The slope relating time to EQ-5D was significantly different when comparing continuers to DBD (0.009, 95% CI 0.002-0.016, P = 0.015). The slopes were not significantly different when comparing continuers to DAD, or when comparing the before and after discontinuation slopes among the discontinuers. With the interaction term removed, there were no significant differences between the three groups for any outcome. None of the pairwise comparisons were statistically significant. There was no significant association between treatment group and presence of GdE or new T2 lesions.
Conclusions: Most patients over age 60 who discontinued DMT remained off DMT. Among the outcomes, only ED-5D demonstrated significance over time, in continuers and discontinuers before stopping treatment. There were also no statistically significant differences in MSPS, T25FW and PHQ-9, new T2 or GdE lesions. Overall, stopping DMT appears to have minimal effect on outcomes over time.
Disclosure: LHH receives personal compensation for speaking, consulting or advisory board activities from Biogen, Genzyme, Genentech, Novartis, Teva, EMD Serono, and TG Therapeutics.
HH has nothing to disclose.
NT receives research support from Novartis for work unrelated to current abstract.
Abstract: P1230
Type: Poster Sessions
Abstract Category: Therapy - Long-term treatment monitoring
Introduction: Current immunomodulatory disease modifying therapies (DMTs) may no longer benefit patients over age 60, due to little inflammatory activity presence or having already reached significant disability, leading clinicians and patients to consider stopping DMT. Our prior study demonstrated that discontinuing DMT can be successful in most patients over age 60.
Objective: This study focuses on changes in outcomes (EQ-5D, MSPS, T25FW, PHQ-9, new T2 or GdE lesions) over time between those who continued vs discontinued DMT.
Methods: Patients were previously identified from our MS clinics who were >60, on DMT for >2 years, with corresponding clinician and patient-reported outcomes (PRO). To compare how outcomes changed over time among treatment groups (continuers, discontinuers before discontinuation (DBD), and discontinuers after discontinuation (DAD)), we created separate mixed-effects linear regression models. We included an interaction term between the time and treatment group to study the trajectory of the outcome. Independent variables were time from age 60 and treatment group, with the following covariates: age at diagnosis, gender, MS course at baseline, time on DMT, baseline DMT and ambulation status at age 60. Among the final models, we made pairwise comparisons among the three treatment groups.
Results: 178 out of 600 patients discontinued DMT. Only the EQ-5D mixed-effects linear regression model with the interaction term was statistically significant (p-value = 0.043). The slope relating time to EQ-5D was significantly different when comparing continuers to DBD (0.009, 95% CI 0.002-0.016, P = 0.015). The slopes were not significantly different when comparing continuers to DAD, or when comparing the before and after discontinuation slopes among the discontinuers. With the interaction term removed, there were no significant differences between the three groups for any outcome. None of the pairwise comparisons were statistically significant. There was no significant association between treatment group and presence of GdE or new T2 lesions.
Conclusions: Most patients over age 60 who discontinued DMT remained off DMT. Among the outcomes, only ED-5D demonstrated significance over time, in continuers and discontinuers before stopping treatment. There were also no statistically significant differences in MSPS, T25FW and PHQ-9, new T2 or GdE lesions. Overall, stopping DMT appears to have minimal effect on outcomes over time.
Disclosure: LHH receives personal compensation for speaking, consulting or advisory board activities from Biogen, Genzyme, Genentech, Novartis, Teva, EMD Serono, and TG Therapeutics.
HH has nothing to disclose.
NT receives research support from Novartis for work unrelated to current abstract.