b'were linked to more rapid disease progression.therapy. AAN Guidelines from 2018 advise Researchers found that patients with progressiveformoreresearchtobedoneregarding disease who discontinued DMTs for two yearshighly active DMTs in the use of CIS. and had an EDSS score of six or greater hadAccording to Dr. Ben Thrower, director of the a 50 percent lower risk of relapse followingMS Institute at Shepherd Center, Ultimately, therapy discontinuation. AAN guidelinesthe decision to stop DMTs should be a shared suggest clinicians may consider discontinuingconversation between patients and physicians.DMTs in non-ambulatory patients (EDSS scores, greater than seven) who have had no activeDr. Thrower went on to explain that no two relapses for the past two years.patients with MS are alike and because Clinically Isolated Syndrome patients with RRMS, progressive MS, and CIS have different rates of disease progression, close In patients with CIS, DMTs may delay themonitoring before and after discontinuation is progression of MS onset. However, not allrecommended. Additionally, RRMS, progressive patients with CIS will develop MS. YoungerMS, and CIS have different responses to patients with CIS have been shown to have aimmunomodulating agents, and it is necessary higher risk of relapse. Therefore, caution shouldto ensure there is no risk when deciding to be exercised when deciding to discontinuestop DMTs. The link between age and relapses has been studied in numerous trials. Some data suggests relapses decrease with age; whereas other data suggests age does not affect relapse rates. A study conducted by the Cleveland Clinic examined the need for DMTs in patients older than 60. This age group is of particular signicance because of the likelihood of patients having comorbidities and a declining immune system. Their finding suggested that discontinuation of DMTs were more successful when age was considered and not just stability of disease state. Researchers found the discontinuation of DMTs was primarily initiated by the physician due to a lack of benets and side effects.A study in Current Opinions in Neurology found relapse rates decreased by 17 percent every ve years of age. Patients with disease onset of greater than 40 years experienced more decreases in relapse rates as they aged. According to the authors, this is especially true for the immunomodulating DMTs (e.g., interferons, Copaxone). A 2022 article published by the Journal of Multiple Sclerosis and Related Disorders suggested that discontinuation of DMTs was linked to disease progression, regardless of age and prior stability of disease. A retrospective study of patients from the New York State MS Consortium saw that patients who experienced disability worsening or progression prior to the discontinuation of DMT experienced less disability worsening or progression after discontinuation when compared to stable patients with no disability worsening or progression prior to discontinuation. Researchers found that RRMS and SPMS patients who were previously stable experienced new disability worsening or progression following the discontinuation of DMTs. For the complete 2018 AAN MS guidelines visit:n.neurology.org/content/92/2/112.longtent/92/2/112.long. 57 msfocusmagazine.org'