Discontinuing disease-modifying therapy in progressive multiple sclerosis: can we stop what we have started?

Area of Science:

• Neurology
• Public Health
• Health Economics

Background:

• Disease-modifying therapies (DMTs) are often continued in progressive multiple sclerosis (MS) patients with high disability (Expanded Disability Status Scale [EDSS] > 6.5) or in primary progressive MS, despite lack of efficacy.
• This continued use represents a significant financial burden on healthcare systems.
• Regular reassessment to discontinue non-beneficial DMTs is recommended but often inaccessible, particularly in rural settings.

Purpose of the Study:

• To evaluate the utilization of DMTs in patients with progressive MS and EDSS > 6.5.
• To investigate the strategies employed by international MS experts regarding the cessation of DMTs in patients with secondary progressive MS (SPMS) without relapses.

Main Methods:

• An epidemiological study was conducted in three Irish regions, recording DMT use in progressive MS patients with EDSS > 6.5.
• An e-questionnaire surveyed 26 MS experts on their approaches to stopping DMTs in SPMS patients.
• Data from 336 patients were analyzed, with a focus on 44 patients having EDSS > 6.5.

Main Results:

• Of 44 patients with progressive MS and EDSS > 6.5, 12 were still receiving DMTs, indicating a lack of benefit for a significant proportion.
• Most surveyed neurologists did not strongly advocate for stopping DMTs in progressive MS, even when ineffective.
• Eleven of the 12 patients receiving non-beneficial DMTs resided in rural areas, highlighting disparities in access to neurology services.

Conclusions:

• A substantial number of patients with advanced MS are on ineffective DMTs, incurring significant costs.
• Discontinuation of ineffective DMTs is not consistently pursued by experts, particularly in rural patient populations.
• Reallocating the substantial costs of non-beneficial DMTs could fund improved neurology services for better patient management.