Related Experiment Video
Updated: Jun 5, 2025
09:38
Determining Immune System Suppression versus CNS Protection for Pharmacological Interventions in Autoimmune Demyelination
Published on: September 12, 2016
12.2K
Discontinuation of First-Line Disease-Modifying Therapy in Patients With Stable Multiple Sclerosis: The DOT-MS
Eline M E Coerver1, Wing Hee Fung1, Janet de Beukelaar2
1Multiple Sclerosis Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam University Medical Center location VUmc, Amsterdam, the Netherlands.
JAMA Neurology
|December 9, 2024
Summary
Discontinuing disease-modifying therapy (DMT) for multiple sclerosis (MS) in patients with long-term stable disease led to a higher recurrence of inflammatory disease activity. This suggests caution is needed when considering stopping MS treatments.
Area of Science:
- Neurology
- Immunology
Background:
- Multiple sclerosis (MS) management increasingly involves disease-modifying therapies (DMTs).
- Long-term disease stability on DMTs prompts consideration for treatment discontinuation due to burden, cost, and side effects.
Purpose of the Study:
- To evaluate the safety of discontinuing first-line DMT in patients with long-term stable MS.
- To determine if MS patients stable for over 5 years on first-line DMT can safely stop treatment.
Main Methods:
- A multicenter, rater-blinded, noninferiority randomized clinical trial involving 89 participants with relapse-onset MS.
- Participants were randomized to either discontinue or continue their first-line DMT.
- The primary outcome was defined as significant inflammatory disease activity (relapse or specific MRI findings).
Main Results:
- The trial was prematurely terminated due to recurrent inflammatory disease activity in the discontinuation group.
- Eight of 45 participants (17.8%) who discontinued DMT experienced inflammatory activity, versus none of the 44 who continued.
- This recurrence rate was higher than in previous studies, particularly in a younger population.
Conclusions:
- Discontinuation of first-line DMT in patients with long-term stable MS (even >5 years) can lead to a significant recurrence of inflammatory disease activity.
- Findings highlight the need for careful consideration and shared decision-making when contemplating DMT cessation.
- This study adds valuable data, especially for younger MS patients, regarding the risks of treatment discontinuation.
Related Concept Videos
01:29Drugs for Treatment of Crohn's Disease in IBD Using Immunomodulatory Agents
142
Crohn's disease is an inflammatory bowel disorder marked by chronic inflammation of the GI tract. Various treatment strategies for Crohn's disease are employed, such as immunomodulatory agents, glucocorticoids, and biologics or anti-TNF therapy. Azathioprine (Imuran), a commonly used immunomodulatory drug for Crohn's disease, is converted in the body to mercaptopurine, which inhibits purine biosynthesis and cell proliferation. Both are utilized in severe cases of Inflammatory Bowel...
142
01:29Inflammatory Bowel Disease IV: Pharmacological Management
112
Upon diagnosis, managing Inflammatory Bowel Disease (IBD) involves addressing several crucial aspects. The primary goals include resting the bowel, correcting malnutrition, and providing symptomatic relief. Resting the bowel may consist of medications to reduce inflammation and promote healing. Correcting malnutrition is essential, often requiring dietary adjustments and nutritional supplements. Symptomatic relief aims to ease pain, diarrhea, and other discomforts in IBD.
Pharmacologic...
Pharmacologic...
112
01:28Drug Therapy
39
The advent of drug therapy has profoundly shaped modern mental health care, providing targeted treatments for a range of psychological disorders. Psychotherapeutic drugs, classified into antianxiety, antidepressant, and antipsychotic medications, address symptoms across anxiety disorders, mood disorders, and schizophrenia. While these medications have transformed patient outcomes, they require careful management due to their potential side effects and limitations.
Antianxiety Medications
Antianxiety Medications
39
01:22Alzheimer's Disease: Treatment
163
Alzheimer's Disease (AD), a neurodegenerative disorder, is pathologically identified by amyloid plaques and neurofibrillary tangles composed of tau protein. AD pharmacotherapy aims to manage cognitive symptoms, delay disease progression, and treat behavioral symptoms. The treatment is primarily symptomatic and palliative, with no definitive disease-modifying therapy available. Cholinesterase inhibitors, including donepezil (Aricept), rivastigmine (Exelon), and galantamine (Razadyne), are...
163
01:21Drugs for Treatment of Crohn's Disease in IBD Using Glucocorticoids
95
Glucocorticoids, a class of anti-inflammatory drugs, are pivotal in treating moderate to severe Crohn's disease by inducing remission. They exhibit their anti-inflammatory action by inhibiting the production of inflammatory cytokines such as tumor necrosis factor (TNF)-α, interleukin (IL)-1, and chemokines like IL-8. In addition, they reduce the expression of inflammatory cell adhesion molecules and inhibit gene transcription of nitric oxide synthase, phospholipase A2, cyclooxygenase-2...
95
01:20Myasthenia Gravis: Overview and Treatment
1.2K
Myasthenia gravis is a neuromuscular transmission disorder characterized by weakness and increased fatigability of skeletal muscles. It is an autoimmune disease affecting approximately one in 2000 people, where antibodies against the α1 subunit of nicotinic acetylcholine receptors are produced.
These antibodies interfere with the function of the nicotinic receptors in three ways: by binding to the receptor and disrupting acetylcholine binding; by causing cross-linking of receptors which...
These antibodies interfere with the function of the nicotinic receptors in three ways: by binding to the receptor and disrupting acetylcholine binding; by causing cross-linking of receptors which...
1.2K