Rethinking Escalation in Relapsing MS

In an interview with Pharmacy Times at the Consortium of Multiple Sclerosis Centers 2026, Patricia K. Coyle, MD, a Director at the MS Center at Stony Brook Medicine, presenting on current evidence surrounding discontinuation and de-escalation of disease-modifying therapies in multiple sclerosis, discusses rethinking escalation strategies in relapsing MS.

Coyle discussed the evolving conversation surrounding discontinuation and de-escalation of disease-modifying therapies (DMTs) in multiple sclerosis (MS), with particular attention to how pharmacists can contribute to long-term treatment decision-making. Drawing on themes related to the DISCOMS trial and broader real-world practice considerations, the discussion explored when clinicians may begin considering therapy discontinuation in patients with stable disease and what factors should guide those decisions.

Key considerations included patient age, duration of disease stability, MRI activity, relapse history, disability progression, and overall risk-benefit assessment. Coyle emphasized the complexity of balancing the potential risks associated with continued immunosuppression—including infection risk and aging-related comorbidities—against the possibility of disease recurrence after stopping or de-escalating therapy. The discussion also highlighted that decisions regarding discontinuation are highly individualized and require careful patient monitoring and shared decision-making.

The conversation further examined how de-escalation strategies may differ from complete discontinuation, particularly in patients transitioning from higher-efficacy therapies. Questions surrounding long-term safety, rebound risk, and ongoing disease surveillance remain important areas of clinical focus as more patients with MS achieve prolonged stability.

From a pharmacist’s perspective, Coyle addressed opportunities for pharmacists to play a larger role in optimizing therapy management throughout the disease course. This includes counseling patients on treatment expectations, reinforcing adherence, monitoring for adverse effects and drug interactions, and helping identify patients who may be appropriate candidates for therapy reassessment. The discussion underscored the importance of multidisciplinary collaboration among neurologists, pharmacists, nurses, and other members of the care team to support individualized and evidence-informed MS management strategies.