De-escalating and discontinuing disease-modifying therapies in multiple sclerosis

Area of Science:

• Neurology
• Immunology
• Pharmacology

Background:

• Disease-modifying therapies (DMTs) have significantly improved multiple sclerosis (MS) management.
• Early DMT initiation in MS is linked to better long-term prognosis.

Purpose of the Study:

• To review evidence on the rationale and potential pitfalls of de-escalating DMTs in MS.
• To discuss clinical scenarios and specific situations for DMT de-escalation.

Main Methods:

• International focused workshop by the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) in 2023.
• Review of current evidence on DMT de-escalation strategies in MS.

Main Results:

• Clinical scenarios for de-escalation are often driven by changing benefit-risk ratios with disease progression and aging.
• Considerations for de-escalation include DMT type, pregnancy, and pediatric MS.

Conclusions:

• Practical guidelines for patient selection, de-escalation, and monitoring are provided.
• Identifies unmet needs in the field of MS treatment de-escalation.