Rethinking Long-Term MS Therapy: De-Escalation, Biomarkers, and the Future of Care

In an interview with Pharmacy Times at the Consortium of Multiple Sclerosis Centers 2026, Jacci Bainbridge, PharmD, FCCP, Professor Vice Chair for Research and Scholarship, Neurology Pharmacy, presenting on current evidence surrounding discontinuation and de-escalation of disease-modifying therapies in multiple sclerosis, discusses rethinking long-term MS therapy, de-escalation, biomarkers and the future of care.

As treatment options continue to evolve in Multiple Sclerosis, clinicians are increasingly facing complex questions surrounding long-term disease management, treatment duration, and risk mitigation in stable patients. In this interview, Bainbridge discusses the growing conversation around balancing the benefits of sustained disease control with concerns related to cumulative immunosuppression, infection risk, aging-related comorbidities, and the potential for disease recurrence after therapy modification.

The discussion also explores where treatment de-escalation strategies may fit into modern MS care, particularly for patients who are hesitant to completely discontinue therapy after years of stability. Bainbridge examines how clinicians are approaching individualized decision-making and what factors may influence whether de-escalation is considered appropriate for certain patients or therapeutic approaches.

In addition, the interview highlights the expanding role of emerging biomarkers and advanced monitoring tools in long-term MS management. Bainbridge discusses how biomarkers such as neurofilament light chain levels and advanced MRI measures may help inform treatment adjustment conversations and provide additional insight into disease activity over time.

Recognizing that many patients experience significant anxiety surrounding the idea of stopping or reducing therapy, the conversation also focuses on shared decision-making and patient communication strategies. Bainbridge addresses the importance of helping patients navigate uncertainty while maintaining trust and collaboration throughout the treatment planning process.

Looking ahead, the interview examines whether MS care may move toward more personalized treatment duration strategies rather than indefinite therapy for most patients. Bainbridge also discusses the important role pharmacists can play in identifying medication-related complications, polypharmacy concerns, adherence challenges, and other factors that may influence long-term treatment planning and patient outcomes in MS care.