Should I stop or should I go on? Disease modifying therapy after the first clinical episode of multiple sclerosis
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ORIGINAL COMMUNICATION
Should I stop or should I go on? Disease modifying therapy after the first clinical episode of multiple sclerosis Tobias Monschein1 · Sabine Salhofer‑Polanyi1 · Patrick Altmann1 · Tobias Zrzavy1 · Assunta Dal‑Bianco1 · Gabriel Bsteh1 · Paulus Rommer1 · Thomas Berger1 · Fritz Leutmezer1 Received: 1 June 2020 / Revised: 7 July 2020 / Accepted: 10 July 2020 © The Author(s) 2020
Abstract Introduction Treatment with disease-modifying therapies (DMT) in patients with clinically isolated syndrome (CIS) represents standard care in multiple sclerosis (MS) patients nowadays. Since a proportion of patients may show no evidence of disease activity (NEDA) after some time of treatment, the question might arise about the risks of stopping DMT. Methods We present a cohort of 49 patients who started DMT immediately after CIS and had no evidence of disease activity (NEDA-3) for at least five years before discontinuation of therapy. Thereafter, patients underwent clinical and MRI followup for at least five consecutive years. Results Of 49 patients discontinuing DMT, 53% (n = 26) had NEDA for at least further five years, while 47% (n = 23) showed either a relapse/disease progression (18.4%, n = 9), MRI activity (14.3%, n = 7) or both (14.3%, n = 7). The main predictive factor for sustained NEDA was age at DMT termination. Patients aged > 45 years had a significantly lower risk of disease reactivation (13% vs. 54% in patients aged
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