b'Medicine & ResearchRX UpdateWWhheennttooSSttooppDDiisseeaasseeMMooddiiffyyiinnggTThheerraappyyBy Ellen Whipple, Pharm.D.In 1993, the rst disease-modifying therapiesIn a randomized control trial of 175 patients gained U.S. Food and Drug Administrationwith RRMS receiving natalizumab who had approval for the treatment of multiple sclerosis.not experienced a relapse in the past year and Sincethen,DMTshaverevolutionizedthehad no new lesions present on MRI, relapses treatment of MS and improved outcomes foroccurred in 4 percent of patients that remained people with the condition. DMTs have shownon therapy. Relapses occurred in 15-29 percent to decrease severity and frequency of relapses,of patients that stopped or switched therapy.and, in some instances, slow the progressionOne observational study examined patients of the disease. But there is an open questionwho did and did not stop DMT therapy after about when its appropriate to stop treatment.being relapse-free for at least ve years. The Atwhatageandunderwhatconditionsstudy found similar risk of relapse between should treatment be discontinued?both groups but saw an increased risk of There are several subtypes of MSincludingdisease progression in patients who stopped relapsing remitting multiple sclerosis,DMTs. In this observational study, younger progressive MS, and clinically isolatedage (younger than 55 years old) and lower syndromesand people with these differentExpanded Disability Status Score scores were subtypes need different approaches tosignicant predictors of relapse following the treatment. This article will address availablediscontinuation of DMTs. It must be noted that evidence regarding when to stop DMTs inthere are no current biomarkers for medication these subtypes.efficacy that can guide the patient and physician Relapsing-remitting in determining how and when to discontinue therapy. Patients and physicians should According to the 2018 American Academycollaborate when discussing if, and when, to of Neurology guidelines, no randomized clinicaldiscontinue therapy.trials directly addressed discontinuing DMTsProgressive MSin patients with RRMS who showed no evidence of relapse or disability progression, or had aFor patients with progressive disease, a stable MRI ndings. According to the guidelines,search of the published biomedical literature when discontinuing DMTs in patients withrevealed no randomized control trials addressing stablerelapsing-remittingMS,monitoringhow and when to discontinue therapy. In from a MS specialist neurologist is still necessarypatients younger than 55 years old, there was since subclinical disease activity and relapsesa higher chance of relapses when DMTs were of disease can occur. discontinued. In many instances, relapses msfocusmagazine.org 56'