Relapse Occurs When Multiple Sclerosis Patients Stop Taking Medication

Long term implications result when patients stop taking disease-modifying drugs.

A large minority of patients who stop taking disease-modifying drugs for the treatment of multiple sclerosis (MS) could experience a return of disease activity if they stop taking their medication, according to new research.

Presented at the annual American Academy of Neurology meeting, an international, multi-site study discovered that approximately 40% of patients experienced a relapse when they stopped treatment.

"Despite long periods of disease stability while taking medication, we found a large minority of patients who stopped experienced relapses or disability progression," study lead author Ilya Kister, MD, said in a press release. "We need to identify situations when it is safe for patients with MS to stop taking these medications."

Because there is limited information regarding disease progression following the discontinuation of first-line, disease-modifying therapies in clinically-stable patients, researchers prospectively examined MS relapse rates and disability progression rates in patients who ceased disease-modifying therapy.

The study included 181 patients age 40 years and older who had not experienced a relapse, who reported stable disability progression for at least 5 years, and who had been taking medication for at least 3 years. Once they stopped taking medications, the patients were followed for at least 3 years.

Following discontinuation of therapy, 24% of patients experienced a clinician-reported relapse, 32% sustained 3-month disability progression, and 10.6% of patients experienced both a relapse and disability progression.

Meanwhile, 77 patients (42%) restarted treatment after a median of 22 months, which was associated with a 59% risk reduction for disability progression.

The study noted that some people stop taking disease-modifying medication for a number of reasons, including debilitating side effects, not feeling better, experiencing symptom exacerbations, and insurance issues.

The researchers concluded there exists a need for a randomized trial for discontinuation of disease-modifying therapy to help determine when exactly it could be safe for patients to cease taking medications.

"Decisions regarding stopping disease-modifying therapy may have implications for short and long-term prognosis,” Dr. Kister said. “We know a lot about what happens when therapy is started, but we know very little about what happens when therapy is stopped.”