Retrospectively Exploring De-Escalation of Multiple Sclerosis Medication: Carolyn H. Goldschmidt, DO


The neurologist at NorthShore University Health System in Chicago discussed a retrospective study on patients with multiple sclerosis who switched from high or moderate efficacy disease-modifying therapies to lower efficacy ones. [WATCH TIME: 5 minutes]

WATCH TIME: 5 minutes

"The risk benefit ratio of a monoclonal antibody is definitely on the side of the highly effective DMT, but as patients get older, they have immune senescence as the disease naturally becomes less active. We're trying to answer, what is the safest choice?”

In the rapidly evolving landscape of multiple sclerosis (MS), clinicians are constantly trying optimize therapeutic approaches for patients. One area of interest is de-escalation, which involves transitioning patients from high or moderate efficacy disease-modifying therapies (DMTs) to lower efficacy ones. Recent news from a retrospective study of 135 patients with MS showed that the most common first-line DMT were dimethyl fumarate (70.4%) and fingolimod (23.7%), whereas the most common second-line DMT were glatiramer acetate (42.2%) and interferons (21.5%).1

Lead author Carolyn H. Goldschmidt, DO, a neurologist at NorthShore University Health System in Chicago, presented the results at the 2023 Consortium of Multiple Sclerosis Centers (CMSC) Annual Meeting, May 31 to June 3, in Aurora, Colorado. In the study, Goldschmidt and colleagues explored the safety of de-escalation of high or moderate efficacy DMTs to low-efficacy treatment on annualized relapse rates (ARR), MRI activity, disability measures, and patient-reported outcomes. Some of the most common reasons for the patients switching DMTs reported in the study were adverse effects, safety concerns, and tolerability.

Following her presentation at the meeting, Goldschmidt sat down in an interview with NeurologyLive® to discuss the significant findings from the retrospective study and the conversations around de-escalating DMTs. She also talked about how the concept of de-escalation fits into the current trend of early, highly intensive therapy for MS patients. In addition, Goldschmidt spoke about some of the challenges in determining the best sequence of DMTs for individual patients with MS, in consideration with the introduction of new treatments like Bruton tyrosine kinase (BTK) inhibitors and stem cell transplants.

Click here for more coverage of CMSC 2023.

1. Goldschmidt CH, Glassman J, Ly B, Harvey T, Hua LE. A Retrospective Study on the Effects of De-Escalation of Disease-Modifying Therapy in Patients With Multiple Sclerosis. Presented at: 2023 CMSC Annual Meeting; May 31 to June 3; Aurora, CO. DMT01.

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