Discontinuation of disease-modifying therapy in patients with multiple sclerosis over age 60

被引:62
作者
Hua, Le H. [1 ,2 ]
Fan, Tracey H. [3 ]
Conway, Devon [2 ]
Thompson, Nicolas [4 ]
Kinzy, Tyler G. [4 ]
机构
[1] Cleveland Clin, Lou Ruvo Ctr Brain Hlth, 888 W Bonneville Ave, Las Vegas, NV 89138 USA
[2] Cleveland Clin, Mellen Ctr Multiple Sclerosis Treatment & Res, Cleveland, OH 44106 USA
[3] Touro Univ Nevada, Sch Med, Las Vegas, NV USA
[4] Cleveland Clin, Dept Quantitat Hlth Sci, Cleveland, OH 44106 USA
关键词
Multiple sclerosis; disease-modifying therapy; discontinuing therapy; long-term management; treatment response; patient-reported outcome measures; proportional hazards models; PERFORMANCE-SCALES; DISABILITY; MS; IMMUNOSENESCENCE; RELAPSES; VALIDITY;
D O I
10.1177/1352458518765656
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Background: The risk-benefit ratio of continuing immunomodulating disease-modifying therapy (DMT) in older multiple sclerosis (MS) patients is unknown. Objective: To evaluate clinical and patient-reported outcomes after stopping DMT in older MS patients. Methods: Retrospective, observational study identifying patients from our MS clinics who were aged over 60 and on DMT > 2 years. Cause-specific Cox proportional hazards regression modeled time to discontinuation and time to reinitiation of therapy. Pre- and post-discontinuation comparisons of Performance Scales (PS), Timed 25-Foot Walk, and Patient Health Questionnaire-9 (PHQ9) were analyzed using linear mixed models. Results: A total of 600 patients were included, with 178 (29.7%) discontinuing. Discontinuers were 2.2 years older, had 3.2 years longer disease duration, and 1.6 years lesser treatment exposure. Providers initiated discontinuation more than patients (68.0%). Only one clinical relapse occurred in discontinuers. A proportion (10.7%) reinitiated DMT. Provider-initiated discontinuers restarted less often (hazard ratio (HR): 0.34; 95% confidence interval (CI): 0.12-0.9). In discontinuers, relapsing-remitting patients had lower PS on average than primary progressive. Provider-initiated discontinuation was associated with lower PS than patient- initiated discontinuation. PHQ9 scores appeared higher in those stopping intravenous (IV) therapies than interferons. Lower PS and PHQ9 indicate better outcomes. Conclusion: Most patients over age 60, who discontinued DMT, remained off DMT. This study provides real-world data that may guide clinicians considering discontinuing DMT.
引用
收藏
页码:699 / 708
页数:10
相关论文
共 20 条
[1]   Multiple Sclerosis in the Elderly Patient [J].
Awad, Amer ;
Stueve, Olaf .
DRUGS & AGING, 2010, 27 (04) :283-294
[2]  
Birnbaum Gary, 2017, Int J MS Care, V19, P11, DOI 10.7224/1537-2073.2015-032
[3]   Discontinuation of disease-modifying therapies in multiple sclerosis - Clinical outcome and prognostic factors [J].
Bsteh, Gabriel ;
Feige, Julia ;
Ehling, Rainer ;
Auer, Michael ;
Hegen, Harald ;
Di Pauli, Franziska ;
Deisenhammer, Florian ;
Reindl, Markus ;
Berger, Thomas .
MULTIPLE SCLEROSIS JOURNAL, 2017, 23 (09) :1241-1248
[4]   Cognitive and Behavioral Consequences of Impaired Immunoregulation in Aging [J].
Corona, Angela W. ;
Fenn, Ashley M. ;
Godbout, Jonathan P. .
JOURNAL OF NEUROIMMUNE PHARMACOLOGY, 2012, 7 (01) :7-23
[5]   Clinically meaningful performance benchmarks in MS Timed 25-Foot Walk and the real world [J].
Goldman, Myla D. ;
Motl, Robert W. ;
Scagnelli, John ;
Pula, John H. ;
Sosnoff, Jacob J. ;
Cadavid, Diego .
NEUROLOGY, 2013, 81 (21) :1856-1863
[6]   Understanding immunosenescence to improve responses to vaccines [J].
Goronzy, Joerg J. ;
Weyand, Cornelia M. .
NATURE IMMUNOLOGY, 2013, 14 (05) :428-436
[7]   Immunosenescence: the Role of Aging in the Predisposition to Neuro-Infectious Complications Arising from the Treatment of Multiple Sclerosis [J].
Grebenciucova, Elena ;
Berger, Joseph R. .
CURRENT NEUROLOGY AND NEUROSCIENCE REPORTS, 2017, 17 (08)
[8]   Measuring the impact of MS on walking ability - The 12-Item MS Walking Scale (MSWS-12) [J].
Hobart, JC ;
Riazi, A ;
Lamping, DL ;
Fitzpatrick, R ;
Thompson, AJ .
NEUROLOGY, 2003, 60 (01) :31-36
[9]  
Katzan Irene, 2011, AMIA Annu Symp Proc, V2011, P683
[10]   Discontinuing disease-modifying therapy in MS after a prolonged relapse-free period: a propensity score-matched study [J].
Kister, Ilya ;
Spelman, Tim ;
Alroughani, Raed ;
Lechner-Scott, Jeannette ;
Duquette, Pierre ;
Grand'Maison, Francois ;
Slee, Mark ;
Lugaresi, Alessandra ;
Barnett, Michael ;
Grammond, Pierre ;
Iuliano, Gerardo ;
Hupperts, Raymond ;
Pucci, Eugenio ;
Trojano, Maria ;
Butzkueven, Helmut .
JOURNAL OF NEUROLOGY NEUROSURGERY AND PSYCHIATRY, 2016, 87 (10) :1133-1137