[Discontinuing disease-modifying therapies in multiple sclerosis].

Area of Science:

• Neurology
• Immunology
• Geriatrics

Context:

• Aging in multiple sclerosis (MS) alters disease presentation, with inflammation driving progression independently of relapses.
• Disease-modifying therapies (DMTs) show reduced efficacy and increased adverse event risk in older MS patients.

Purpose:

• To evaluate the implications of aging on multiple sclerosis pathophysiology and treatment effectiveness.
• To address the question of whether MS therapies should be discontinued in older patients, particularly those over 55.

Summary:

• MS pathophysiology shifts towards compartmentalized inflammation with aging, impacting clinical manifestations.
• Treatment discontinuation studies in older MS patients indicate a potential for slight increases in disease activity but not significant disability progression.
• The decision to cease DMTs should be individualized, factoring in comorbidities, and followed by diligent monitoring.

Impact:

• Provides evidence to inform clinical decisions regarding DMT use in aging MS populations.
• Highlights the need for personalized treatment strategies and vigilant follow-up for elderly MS patients.
• Contributes to understanding the long-term management of multiple sclerosis in an aging demographic.