Stopping Therapy in Multiple Sclerosis and DISCOMS Trial: Long-Term Strategies

For patients with stable Multiple SclerosisMS, several long-term management strategies can be considered to maintain disease control while minimizing treatment risks and burden. One option is to continue the current disease-modifying therapy (DMT) if it is well tolerated and effectively controlling disease activity. However, in some cases, stopping treatment may be discussed, especially for patients who have been stable for many years without relapses or new MRI activity. Stopping treatment requires careful consideration and close monitoring due to the risk of disease reactivation after therapy withdrawal.

Another approach is de-escalation of therapy, which involves reducing the intensity or frequency of treatment to lower potential sideadverse effects while still maintaining disease control. This strategy can be particularly useful for patients who have stable disease but face high treatment burden or increased risk of infections and other complications. De-escalation can mean switching to a less potent DMT or extending dosing intervals, balancing safety with efficacy. Physicians typically tailor this approach based on individual patient factors, disease history, and risk tolerance.

Switching to another treatment is also a viable option for patients with stable MS, especially if there are concerns about sideadverse effects or long-term safety with the current therapy. The decision to switch is often influenced by new therapeutic options, patient preferences, and emerging evidence about the benefits and risks of different DMTs. Ultimately, long-term management of stable MS requires a personalized approach, emphasizing regular clinical and imaging assessments to ensure ongoing disease control and adapting therapy plans as needed to optimize patient quality of life.