title: Discontinuation of disease modifying treatments in middle aged multiple sclerosis patients. First line drugs vs natalizumab.
abstract: BACKGROUND
  Several disease-modifying drugs (DMD) are available for the treatment of MS, and most patients with relapsing-remitting disease are currently treated. Data on when and how DMD treatment can be safely discontinued are scarce.
  
  
  METHODS
  Fifteen MS patients, treated with natalizumab for >5 years without clinical and radiological signs of inflammatory disease activity, suspended treatment and were monitored with MRI examinations and clinical follow-up to determine recurrence of disease activity. This group was compared with a retrospectively analysed cohort comprising 55 MS patients treated with first-line DMDs discontinuing therapy in the time period of 1998-2015 after an analogous stable course.
  
  
  RESULTS
  Natalizumab discontinuers were followed for on average 19 months, and follow-up data for 56 months were available for first-line DMD quitters. Two-thirds of natalizumab treated patients experienced recurrent inflammatory disease activity, and one third had recurrence of rebound character. In contrast, 35% of first-line DMD quitters had mild recurrent disease activity, and no one exhibited rebound.
  
  
  CONCLUSIONS
  Withdrawal of a first-line DMD after prolonged treatment in middle-aged MS patients with stable disease appears to be relatively safe, while natalizumab withdrawal in a similar group of patients cannot be safely done without starting alternative therapy.
authors.affiliation: Department of Neuroscience, Uppsala University, Uppsala, Sweden. Electronic address: jan.fagius@neuro.uu.se.
authors.forename: Jan
authors.initials: J
authors.lastname: Fagius
authors.affiliation: Department of Neuroscience, Uppsala University, Uppsala, Sweden.
authors.forename: Amalia
authors.initials: A
authors.lastname: Feresiadou
authors.affiliation: Department of Surgical Sciences/Radiology, Uppsala University, Uppsala, Sweden.
authors.forename: Elna-Marie
authors.initials: EM
authors.lastname: Larsson
authors.affiliation: Department of Neuroscience, Uppsala University, Uppsala, Sweden.
authors.forename: Joachim
authors.initials: J
authors.lastname: Burman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000453:epidemiology* / Q000503:physiopathology; D000069442:Natalizumab / Q000627:therapeutic use*; D010352:Patient Dropouts / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012008:Recurrence; D012042:Registries; D012189:Retrospective Studies; D012306:Risk; D013548:Sweden / Q000453:epidemiology; D017211:Treatment Failure; D028761:Withholding Treatment; D055815:Young Adult
chemical_list: D007155:Immunologic Factors; D000069442:Natalizumab
keywords: Multiple sclerosis; Natalizumab discontinuation; Rebound; Treatment discontinuation