Background

Treatments may become redundant in older patients with multiple sclerosis (MS). Our aim was to explore whether stopping treatments might be possible in patients aged over 50 with disease inactivity.

Methods

Patients over 50 were included from the population-based MS Lorraine registry if they had a relapsing–remitting course at onset and had experienced no relapse for ≥ 3 years. Patients who stopped treatments were defined as “stoppers”, and the others as “stayers”. The outcomes were the time to first relapse, to first disability progression, and to the occurrence of EDSS score of 6, assessed by multivariate analysis using a propensity score.

Results

132 stoppers and 366 stayers had a median follow-up of 7 years. There was no difference in Log-rank tests for the times to first relapse (p = 0.61) and to first disability progression (p = 0.22). In Cox models, stopping treatments was not associated with an increased risk of relapse (adjusted Hazard ratio (aHR) = 0.92 [0.72–1.16; p = 0.47]) or of an increase in EDSS score (aHR = 0.89 [0.71–1.13; p = 0.34]). However, stopping was associated with a higher risk of occurrence of EDSS score of 6 (aHR = 3.29 [2.22–4.86; p < 0.0001]), with a significant difference for the time to occurrence of EDSS score of 6 (p = 0.003).

Conclusion

Our study suggests that stopping injectable disease-modifying treatments, in patients over 50 with disease inactivity, is not associated with an increased risk of relapse or EDSS progression, but there might be a higher risk of reaching EDSS 6. These results have to be confirmed by interventional studies.

中文翻译：

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50岁以上无活动的患者中止多发性硬化症的缓解疾病的治疗方法。

背景

对于老年多发性硬化症（MS）患者，治疗可能变得多余。我们的目的是探讨对于患有疾病的50岁以上患者是否可以停止治疗。

方法

如果年龄超过50岁的患者在发作时具有复发缓解过程且≥3年没有复发，则从基于人口的MS Lorraine登记册中纳入。停止治疗的患者被定义为“停止者”，其他被定义为“停留者”。结果是首次复发，第一次残疾进展和发生EDSS评分6的时间，通过使用倾向评分的多变量分析进行评估。

结果

132名塞者和366名住宿者中位随访7年。首次复发时间（p  = 0.61）和首次残疾进展时间（p = 0.22）的对 数秩检验没有差异。在Cox模型中，停止治疗与复发风险增加（调整的危险比（aHR）= 0.92 [0.72-1.16；p = 0.47]）或EDSS评分增加（aHR = 0.89 [0.71-1.13；p  = 0.47]）无关。p  = 0.34]）。然而，停止与发生EDSS评分为6的较高风险相关（aHR = 3.29 [2.22-4.86；p  <0.0001]），与发生EDSS评分为6的时间有显着差异（p  = 0.003） 。

结论

我们的研究表明，对于50岁以上无运动能力的患者，停止注射可改变疾病的治疗方法不会增加复发或EDSS进展的风险，但达到EDSS 6的风险可能更高。这些结果必须得到证实通过干预研究。