Discontinuation of Disease Modifying Therapies in Stable MS Patients is Associated with Disability Progression Regardless of Age

Objective: To assess the effects of treatment discontinuation on disability worsening in multiple sclerosis (MS) patients with long disease duration. Background: Patients with MS (pwMS) with a stable disease course might view continued treatment as unnecessary. Therapy discontinuation in an aging population is often recommended, but clear data supporting this is lacking. Design/Methods: Patients who discontinued disease modifying therapies (DMTs) and did not resume treatment (n=193) were extracted from the New York State MS Consortium (NYSMSC) and followed across three time points (approximately 3.8 years). Stable disability course was defined as no change in Expanded Disability Status Scale (EDSS) scores (less than a one-point increase if EDSS Results: Of the 193 pwMS, 135 (69.9%) were classified as stable prior to discontinuing treatment while 58 (30.1%) were not. The mean age was 50.4 years (SD=11.6) with a disease duration of 17.1 years (SD=9.8). There were no significant group differences in age, sex, disease duration, or EDSS scores prior to discontinuation. Of the 135 stable patients, 48 (35.6%) worsened in EDSS scores after discontinuation (34.1% in patients Conclusions: A stable disease course does not protect against disability progression after treatment discontinuation, with no clear relation with age. Disclosure: Dr. Weinstock-Guttman has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Bianca Weinstock- Guttman received honoraria as a speaker and as a consultant for Biogen Idec, Teva Pharmaceuticals, EMD Serono, GenzymeS grant support from the National Multiple Sclerosis Society, National Institutes of Health and the Department of Defense. Dr. Krupp has received research support from research support from Novartis, Biogen Idec, Celgene Corporation and Genentech and support from the Lourie Foundation, Slomo and Cindy Silvian Foundation and the Multiple Sclerosis Foundation. Dr. Gottesman has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Biogen, Teva, and Genzyme. Dr. Edwards has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Genzyme. Dr. Edwards has received research support from Biogen, Genzyme, Genentech, Novartis, Eli Lilly. Dr. Lenihan has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Sanofi-Genzyme. Dr. Perel has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Biogen, Genzyme-Sanofi,Teva, EDM Serono, Bayer, Novartis, Mallincrodt, Genentech, Acorda. Dr. Zivadinov has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities from EMD Serono, Genzyme-Sanofi, Claret Medical, Celgene and Novartis for speaking and consultant fees. Financial support for research activities from Genzyme-Sanofi, Novartis, Claret Medical, Intekrin-Coherus and Quintiles IMS.