The Takeaway From Study of Midlife MS Patients: Don't Stop Disease-Modifying Therapy

Multiple sclerosis (MS) is characterized by chronic inflammation leading to central nervous system demyelination. Almost 90% of people with MS have relapsing-remitting MS (RRMS) or secondary progressive MS (SPMS). RRMS typically occurs early in the disease progression, and SPMS represents the later stages of MS.

MS is typically diagnosed between the ages of 20 and 40 years, and patients usually progress from RRMS to SPMS around the age of 50. As the disease progresses, patients tend to experience fewer relapses and less disease activity but show more evidence of neuronal degeneration.

Current treatment guidelines recommend starting disease-modifying therapies soon after disease onset. These treatments have significantly contributed to improving survival and shifting the peak age of prevalence for MS from 30 to 39 years in 1975 to 50 to 65 years in 2017.

However, as patients age and transition from RRMS to SPMS, DMTs show reduced efficacy and demonstrate fewer clinical benefits for the patient. clinicians often consider discontinuing DMTs when patients reach this stage of the disease to reduce treatment burden, such as increased risk of infection and liver or kidney impairment associated with prolonged DMT use.

Still, there is limited evidence elucidating the effect of discontinuing DMTs midlife on healthcare utilization in patients with MS. To help answer this question, a team of researchers led by Yiran Qian, M.D., Ph.D., from the division of pharmaceutical outcomes and policy at the Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, conducted a study using data from the IBM MarketScan Commercial Claims and Encounters data source.

The results were published in the November 2024, issue of the Journal of Managed Care and Specialty Pharmacy.

The study included patients ages 45 to 64 years (midlife) who were prescribed a DMT for MS between January 1, 2001, and December 31, 2018. The mean patient age was 54 years. The researchers identified patients who discontinued DMTs (defined as a treatment gap of over 90 days in days supply) and compared them with similar MS patients who did not discontinue DMTs. During a 365-day follow-up, Qian and colleagues evaluated all-cause, MS-related, and non-MS-related hospitalizations and emergency department visits and relapse-related hospitalizations and outpatient visits.

Of nearly 150,000 patients included in the study, 22.8% discontinued DMTs, and 77.2% did not discontinue treatment. Patients who discontinued DMTs had a 10.3% higher rate of all-cause hospitalizations and a 24.9% higher rate of non-MS-related hospitalizations compared with those who continued treatment. There were no significant differences in MS-related hospitalizations between the two groups.

When evaluating emergency department visits, the researchers found that patients who discontinued DMTs had 21.3%, 23%, and 20.9% higher rates of all-cause, MS-related, and non-MS-related emergency department visits, respectively, compared with patients who did not discontinue DMTs. Finally, the study results showed a 15.9% higher rate of relapse-related hospitalizations and a 52.1% higher rate of relapse-related outpatient visits for patients who discontinued DMTs versus those who continued treatment.

The researchers concluded that discontinuation of DMTs in midlife patients with MS is associated with increased rates of healthcare resource utilization, particularly for relapse-related outpatient visits. They recommend that providers evaluate patients individually when considering DMT discontinuation and advocate for future research to determine whether discontinuation of DMTs should be shifted to later in life.