When to Stop Multiple Sclerosis Therapy

Opinion
Video

Ahmed Obeidat, MD, PhD, Erin Longbrake, MD, PhD, Stephen Krieger, MD, and Riley Bove, MD, discuss strategies for personalizing decisions and mitigating risks when stopping medication.

This is a video synopsis/summary of a panel discussion involving Ahmed Obeidat, MD, PhD; Riley Bove, MD; Stephen Krieger, MD; and Erin Longbrake, MD, PhD.

When considering discontinuing therapy for patients with stable multiple sclerosis (MS) who show no signs of inflammatory activity, the decision-making process is typically a shared 1 with the patient. One often considers stopping medication for older patients who have been stable for many years without new lesions, relapses, or enhancing lesions.

However, patients are generally hesitant to change their stable treatment regimens. Situations where therapy might be stopped often arise when additional risks, like infections, become apparent. In such cases, adjusting the treatment or discussing discontinuation with the patient may be considered.

The decision to stop medication is complex and relies heavily on shared decision-making and clinical experience due to the lack of definitive data to guide the decision. Regular monitoring is crucial to assess the evolving risk-benefit ratio.

There's also a challenge in determining whether the absence of relapses is due to the patient's biology or the effectiveness of the medication. This uncertainty underscores the importance of continued vigilance and monitoring, especially when considering discontinuing B-cell depleting therapies.

Cell-depleting immunotherapies are believed to have longer-lasting effects, providing some reassurance when considering discontinuation. However, vigilant monitoring remains essential, especially as B-cells come back online after discontinuation, to understand their activity and potential impact on the patient's condition.

Video synopsis is AI-generated and reviewed by NeurologyLive editorial staff.

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