Systematic review on the wearing-off phenomenon of disease-modifying therapies in managing multiple sclerosis

Multiple sclerosis (MS) is a progressive neurological disorder managed with Disease Modifying Therapies (DMTs). While these therapies improve outcomes, monoclonal antibody-based DMTs face challenges such as the wearing-off phenomenon. Despite increasing recognition, this phenomenon remains poorly understood, necessitating a comprehensive evidence synthesis. This systematic review is the first comprehensive evaluation of the wearing-off phenomenon in MS patients treated with monoclonal antibody therapies.

A systematic review and meta-analysis were conducted following PRISMA guidelines. The primary outcome was the change in Expanded Disability Status Scale (EDSS) scores between patients with and without the wearing-off phenomenon. The secondary outcome evaluated the association between disease duration, DMT regimen, and wearing-off symptoms.

Fourteen studies involving 1752 participants met the inclusion criteria. The prevalence of the wearing-off phenomenon was 54.02%, predominantly manifesting as fatigue, walking difficulties, and cognitive impairment. No significant associations were observed between wearing-off symptoms and EDSS scores (SMD = 0.04, 95% CI:0.44 to 0.52, p = 0.8310) or disease duration (SMD = -0.26, 95% CI:1.86 to 1.33, p = 0.6985). Extended Interval Dosing did not significantly reduce the risk of the wearing-off phenomenon compared to Standard Interval Dosing (RR = 0.88, 95% CI: 0.44 to 1.57, p = 0.6049).

Despite its high prevalence, the phenomenon correlates with EDSS score or disease duration. Further longitudinal studies are needed to find the underlying pathophysiology, identify reliable biomarkers, and develop targeted interventions to improve patient outcomes and treatment satisfaction.