Risk of new disease activity in patients with multiple sclerosis who continue or discontinue disease-modifying therapies (DISCOMS): a multicentre, randomised, single-blind, phase 4, non-inferiority trial

Multiple sclerosis typically has onset in young adults and new disease activity diminishes with age. Most clinical trials of disease-modifying therapies for multiple sclerosis have not enrolled individuals older than 55 years. Observational studies suggest that risk of return of disease activity aft...

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Published inLancet neurology Vol. 22; no. 7; pp. 568 - 577
Main Authors Corboy, John R, Fox, Robert J, Kister, Ilya, Cutter, Gary R, Morgan, Charity J, Seale, Rebecca, Engebretson, Eric, Gustafson, Tarah, Miller, Aaron E, Bourdette, Dennis, Yadav, Vijayshree, Goodman, Andrew, Racke, Michael, Fallis, Robert, Tornatore, Carlo, Goldman, Myla, Kannan, Meena, Sriram, Subramaniam, Berger, Joseph, Cross, Anne, Rammohan, Kottil, Xia, Zongqi, Leist, Thomas, Lynch, Sharon, Klawiter, Eric, Amezcua, Lilyana, Bowen, James
Format Journal Article
LanguageEnglish
Published England Elsevier Ltd 01.07.2023
Elsevier Limited
Subjects
Adverse events
Age
Aged
Clinical trials
Disability
Double-Blind Method
FDA approval
Humans
Lesions
Magnetic Resonance Imaging
Multiple sclerosis
Multiple Sclerosis - diagnostic imaging
Multiple Sclerosis - drug therapy
Neuroimaging
Observational studies
Patients
Risk assessment
Single-Blind Method
Treatment Outcome
Young Adult
Young adults
United States > US
Online AccessGet full text
ISSN1474-4422
1474-4465
1474-4465
DOI10.1016/S1474-4422(23)00154-0

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Abstract Multiple sclerosis typically has onset in young adults and new disease activity diminishes with age. Most clinical trials of disease-modifying therapies for multiple sclerosis have not enrolled individuals older than 55 years. Observational studies suggest that risk of return of disease activity after discontinuation of a disease-modifying therapies is greatest in younger patients with recent relapses or MRI activity. We aimed to determine whether risk of disease recurrence in older patients with no recent disease activity who discontinue disease-modifying therapy is increased compared to those who remain on disease-modifying therapy. DISCOMS was a multicentre, randomised, controlled, rater-blinded, phase 4, non-inferiority trial. Individuals with multiple sclerosis of any subtype, 55 years or older, with no relapse within the past 5 years or new MRI lesion in the past 3 years while continuously taking an approved disease-modifying therapy were enrolled at 19 multiple sclerosis centres in the USA. Participants were randomly assigned (1:1 by site) with an interactive response technology system to either continue or discontinue disease-modifying therapy. Relapse assessors and MRI readers were masked to patient assignment; patients and treating investigators were not masked. The primary outcome was percentage of individuals with a new disease event, defined as a multiple sclerosis relapse or a new or expanding T2 brain MRI lesion, over 2 years. We assessed whether discontinuation of disease-modifying therapy was non-inferior to continuation using a non-inferiority, intention-to-treat analysis of all randomly assigned patients, with a predefined non-inferiority margin of 8%. This trial is registered at ClinicalTrials.gov, NCT03073603, and is completed. 259 participants were enrolled between May 22, 2017, and Feb 3, 2020; 128 (49%) were assigned to the continue group and 131 (51%) to the discontinue group. Five participants were lost to follow-up (continue n=1, discontinue n=4). Six (4·7%) of 128 participants in the continue group and 16 (12·2%) of 131 in the discontinue group had a relapse or a new or expanding brain MRI lesion within 2 years. The difference in event rates was 7·5 percentage points (95% CI 0·6–15·0). Similar numbers of participants had adverse events (109 [85%] of 128 vs 104 [79%] of 131) and serious adverse events (20 [16%] vs 18 [14%]), but more adverse events (422 vs 347) and serious adverse events (40 vs 30) occurred in the discontinue group. The most common adverse events were upper respiratory infections (20 events in 19 [15%] participants in the continue group and 37 events in 30 [23%] participants in the discontinue group). Three participants in the continue group and four in the discontinue group had treatment-related adverse events, of which one in each group was a serious adverse event (multiple sclerosis relapse requiring admission to hospital). One participant in the continue group and two in the discontinue group died; no deaths were deemed to be related to treatment. We were unable to reject the null hypothesis and could not conclude whether disease-modifying therapy discontinuation is non-inferior to continuation in patients older than 55 years with multiple sclerosis and no recent relapse or new MRI activity. Discontinuation of disease-modifying therapy might be a reasonable option in patients older than 55 years who have stable multiple sclerosis, but might be associated with a small increased risk of new MRI activity. Patient-Centered Outcomes Research Institute and the National Multiple Sclerosis Society.
AbstractList Multiple sclerosis typically has onset in young adults and new disease activity diminishes with age. Most clinical trials of disease-modifying therapies for multiple sclerosis have not enrolled individuals older than 55 years. Observational studies suggest that risk of return of disease activity after discontinuation of a disease-modifying therapies is greatest in younger patients with recent relapses or MRI activity. We aimed to determine whether risk of disease recurrence in older patients with no recent disease activity who discontinue disease-modifying therapy is increased compared to those who remain on disease-modifying therapy.BACKGROUNDMultiple sclerosis typically has onset in young adults and new disease activity diminishes with age. Most clinical trials of disease-modifying therapies for multiple sclerosis have not enrolled individuals older than 55 years. Observational studies suggest that risk of return of disease activity after discontinuation of a disease-modifying therapies is greatest in younger patients with recent relapses or MRI activity. We aimed to determine whether risk of disease recurrence in older patients with no recent disease activity who discontinue disease-modifying therapy is increased compared to those who remain on disease-modifying therapy.DISCOMS was a multicentre, randomised, controlled, rater-blinded, phase 4, non-inferiority trial. Individuals with multiple sclerosis of any subtype, 55 years or older, with no relapse within the past 5 years or new MRI lesion in the past 3 years while continuously taking an approved disease-modifying therapy were enrolled at 19 multiple sclerosis centres in the USA. Participants were randomly assigned (1:1 by site) with an interactive response technology system to either continue or discontinue disease-modifying therapy. Relapse assessors and MRI readers were masked to patient assignment; patients and treating investigators were not masked. The primary outcome was percentage of individuals with a new disease event, defined as a multiple sclerosis relapse or a new or expanding T2 brain MRI lesion, over 2 years. We assessed whether discontinuation of disease-modifying therapy was non-inferior to continuation using a non-inferiority, intention-to-treat analysis of all randomly assigned patients, with a predefined non-inferiority margin of 8%. This trial is registered at ClinicalTrials.gov, NCT03073603, and is completed.METHODSDISCOMS was a multicentre, randomised, controlled, rater-blinded, phase 4, non-inferiority trial. Individuals with multiple sclerosis of any subtype, 55 years or older, with no relapse within the past 5 years or new MRI lesion in the past 3 years while continuously taking an approved disease-modifying therapy were enrolled at 19 multiple sclerosis centres in the USA. Participants were randomly assigned (1:1 by site) with an interactive response technology system to either continue or discontinue disease-modifying therapy. Relapse assessors and MRI readers were masked to patient assignment; patients and treating investigators were not masked. The primary outcome was percentage of individuals with a new disease event, defined as a multiple sclerosis relapse or a new or expanding T2 brain MRI lesion, over 2 years. We assessed whether discontinuation of disease-modifying therapy was non-inferior to continuation using a non-inferiority, intention-to-treat analysis of all randomly assigned patients, with a predefined non-inferiority margin of 8%. This trial is registered at ClinicalTrials.gov, NCT03073603, and is completed.259 participants were enrolled between May 22, 2017, and Feb 3, 2020; 128 (49%) were assigned to the continue group and 131 (51%) to the discontinue group. Five participants were lost to follow-up (continue n=1, discontinue n=4). Six (4·7%) of 128 participants in the continue group and 16 (12·2%) of 131 in the discontinue group had a relapse or a new or expanding brain MRI lesion within 2 years. The difference in event rates was 7·5 percentage points (95% CI 0·6-15·0). Similar numbers of participants had adverse events (109 [85%] of 128 vs 104 [79%] of 131) and serious adverse events (20 [16%] vs 18 [14%]), but more adverse events (422 vs 347) and serious adverse events (40 vs 30) occurred in the discontinue group. The most common adverse events were upper respiratory infections (20 events in 19 [15%] participants in the continue group and 37 events in 30 [23%] participants in the discontinue group). Three participants in the continue group and four in the discontinue group had treatment-related adverse events, of which one in each group was a serious adverse event (multiple sclerosis relapse requiring admission to hospital). One participant in the continue group and two in the discontinue group died; no deaths were deemed to be related to treatment.FINDINGS259 participants were enrolled between May 22, 2017, and Feb 3, 2020; 128 (49%) were assigned to the continue group and 131 (51%) to the discontinue group. Five participants were lost to follow-up (continue n=1, discontinue n=4). Six (4·7%) of 128 participants in the continue group and 16 (12·2%) of 131 in the discontinue group had a relapse or a new or expanding brain MRI lesion within 2 years. The difference in event rates was 7·5 percentage points (95% CI 0·6-15·0). Similar numbers of participants had adverse events (109 [85%] of 128 vs 104 [79%] of 131) and serious adverse events (20 [16%] vs 18 [14%]), but more adverse events (422 vs 347) and serious adverse events (40 vs 30) occurred in the discontinue group. The most common adverse events were upper respiratory infections (20 events in 19 [15%] participants in the continue group and 37 events in 30 [23%] participants in the discontinue group). Three participants in the continue group and four in the discontinue group had treatment-related adverse events, of which one in each group was a serious adverse event (multiple sclerosis relapse requiring admission to hospital). One participant in the continue group and two in the discontinue group died; no deaths were deemed to be related to treatment.We were unable to reject the null hypothesis and could not conclude whether disease-modifying therapy discontinuation is non-inferior to continuation in patients older than 55 years with multiple sclerosis and no recent relapse or new MRI activity. Discontinuation of disease-modifying therapy might be a reasonable option in patients older than 55 years who have stable multiple sclerosis, but might be associated with a small increased risk of new MRI activity.INTERPRETATIONWe were unable to reject the null hypothesis and could not conclude whether disease-modifying therapy discontinuation is non-inferior to continuation in patients older than 55 years with multiple sclerosis and no recent relapse or new MRI activity. Discontinuation of disease-modifying therapy might be a reasonable option in patients older than 55 years who have stable multiple sclerosis, but might be associated with a small increased risk of new MRI activity.Patient-Centered Outcomes Research Institute and the National Multiple Sclerosis Society.FUNDINGPatient-Centered Outcomes Research Institute and the National Multiple Sclerosis Society.
Multiple sclerosis typically has onset in young adults and new disease activity diminishes with age. Most clinical trials of disease-modifying therapies for multiple sclerosis have not enrolled individuals older than 55 years. Observational studies suggest that risk of return of disease activity after discontinuation of a disease-modifying therapies is greatest in younger patients with recent relapses or MRI activity. We aimed to determine whether risk of disease recurrence in older patients with no recent disease activity who discontinue disease-modifying therapy is increased compared to those who remain on disease-modifying therapy. DISCOMS was a multicentre, randomised, controlled, rater-blinded, phase 4, non-inferiority trial. Individuals with multiple sclerosis of any subtype, 55 years or older, with no relapse within the past 5 years or new MRI lesion in the past 3 years while continuously taking an approved disease-modifying therapy were enrolled at 19 multiple sclerosis centres in the USA. Participants were randomly assigned (1:1 by site) with an interactive response technology system to either continue or discontinue disease-modifying therapy. Relapse assessors and MRI readers were masked to patient assignment; patients and treating investigators were not masked. The primary outcome was percentage of individuals with a new disease event, defined as a multiple sclerosis relapse or a new or expanding T2 brain MRI lesion, over 2 years. We assessed whether discontinuation of disease-modifying therapy was non-inferior to continuation using a non-inferiority, intention-to-treat analysis of all randomly assigned patients, with a predefined non-inferiority margin of 8%. This trial is registered at ClinicalTrials.gov, NCT03073603, and is completed. 259 participants were enrolled between May 22, 2017, and Feb 3, 2020; 128 (49%) were assigned to the continue group and 131 (51%) to the discontinue group. Five participants were lost to follow-up (continue n=1, discontinue n=4). Six (4·7%) of 128 participants in the continue group and 16 (12·2%) of 131 in the discontinue group had a relapse or a new or expanding brain MRI lesion within 2 years. The difference in event rates was 7·5 percentage points (95% CI 0·6-15·0). Similar numbers of participants had adverse events (109 [85%] of 128 vs 104 [79%] of 131) and serious adverse events (20 [16%] vs 18 [14%]), but more adverse events (422 vs 347) and serious adverse events (40 vs 30) occurred in the discontinue group. The most common adverse events were upper respiratory infections (20 events in 19 [15%] participants in the continue group and 37 events in 30 [23%] participants in the discontinue group). Three participants in the continue group and four in the discontinue group had treatment-related adverse events, of which one in each group was a serious adverse event (multiple sclerosis relapse requiring admission to hospital). One participant in the continue group and two in the discontinue group died; no deaths were deemed to be related to treatment. We were unable to reject the null hypothesis and could not conclude whether disease-modifying therapy discontinuation is non-inferior to continuation in patients older than 55 years with multiple sclerosis and no recent relapse or new MRI activity. Discontinuation of disease-modifying therapy might be a reasonable option in patients older than 55 years who have stable multiple sclerosis, but might be associated with a small increased risk of new MRI activity. Patient-Centered Outcomes Research Institute and the National Multiple Sclerosis Society.
Summary Background Multiple sclerosis typically has onset in young adults and new disease activity diminishes with age. Most clinical trials of disease-modifying therapies for multiple sclerosis have not enrolled individuals older than 55 years. Observational studies suggest that risk of return of disease activity after discontinuation of a disease-modifying therapies is greatest in younger patients with recent relapses or MRI activity. We aimed to determine whether risk of disease recurrence in older patients with no recent disease activity who discontinue disease-modifying therapy is increased compared to those who remain on disease-modifying therapy. Methods DISCOMS was a multicentre, randomised, controlled, rater-blinded, phase 4, non-inferiority trial. Individuals with multiple sclerosis of any subtype, 55 years or older, with no relapse within the past 5 years or new MRI lesion in the past 3 years while continuously taking an approved disease-modifying therapy were enrolled at 19 multiple sclerosis centres in the USA. Participants were randomly assigned (1:1 by site) with an interactive response technology system to either continue or discontinue disease-modifying therapy. Relapse assessors and MRI readers were masked to patient assignment; patients and treating investigators were not masked. The primary outcome was percentage of individuals with a new disease event, defined as a multiple sclerosis relapse or a new or expanding T2 brain MRI lesion, over 2 years. We assessed whether discontinuation of disease-modifying therapy was non-inferior to continuation using a non-inferiority, intention-to-treat analysis of all randomly assigned patients, with a predefined non-inferiority margin of 8%. This trial is registered at ClinicalTrials.gov, NCT03073603, and is completed. Findings 259 participants were enrolled between May 22, 2017, and Feb 3, 2020; 128 (49%) were assigned to the continue group and 131 (51%) to the discontinue group. Five participants were lost to follow-up (continue n=1, discontinue n=4). Six (4·7%) of 128 participants in the continue group and 16 (12·2%) of 131 in the discontinue group had a relapse or a new or expanding brain MRI lesion within 2 years. The difference in event rates was 7·5 percentage points (95% CI 0·6–15·0). Similar numbers of participants had adverse events (109 [85%] of 128 vs 104 [79%] of 131) and serious adverse events (20 [16%] vs 18 [14%]), but more adverse events (422 vs 347) and serious adverse events (40 vs 30) occurred in the discontinue group. The most common adverse events were upper respiratory infections (20 events in 19 [15%] participants in the continue group and 37 events in 30 [23%] participants in the discontinue group). Three participants in the continue group and four in the discontinue group had treatment-related adverse events, of which one in each group was a serious adverse event (multiple sclerosis relapse requiring admission to hospital). One participant in the continue group and two in the discontinue group died; no deaths were deemed to be related to treatment. Interpretation We were unable to reject the null hypothesis and could not conclude whether disease-modifying therapy discontinuation is non-inferior to continuation in patients older than 55 years with multiple sclerosis and no recent relapse or new MRI activity. Discontinuation of disease-modifying therapy might be a reasonable option in patients older than 55 years who have stable multiple sclerosis, but might be associated with a small increased risk of new MRI activity. Funding Patient-Centered Outcomes Research Institute and the National Multiple Sclerosis Society.
Author Fox, Robert J
Xia, Zongqi
Miller, Aaron E
Engebretson, Eric
Sriram, Subramaniam
Cutter, Gary R
Rammohan, Kottil
Fallis, Robert
Cross, Anne
Tornatore, Carlo
Leist, Thomas
Lynch, Sharon
Amezcua, Lilyana
Goodman, Andrew
Kannan, Meena
Goldman, Myla
Racke, Michael
Gustafson, Tarah
Morgan, Charity J
Berger, Joseph
Bourdette, Dennis
Corboy, John R
Bowen, James
Kister, Ilya
Seale, Rebecca
Klawiter, Eric
Yadav, Vijayshree
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BackLink https://www.ncbi.nlm.nih.gov/pubmed/37353277$$D View this record in MEDLINE/PubMed
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Cites_doi 10.1136/jnnp.2008.145805
10.1177/1352458507078388
10.7224/1537-2073.2015-032
10.1177/135245859900500508
10.1212/WNL.0000000000000560
10.1002/ana.22366
10.1177/1352458514530489
10.1007/s00415-021-10823-z
10.1017/S1092852918001517
10.1080/23279095.2015.1125905
10.1212/WNL.0000000000201029
10.1001/jamaneurol.2021.3416
10.1212/WNL.0000000000005347
10.1016/j.msard.2021.103308
10.1016/j.msard.2019.07.021
10.1177/1352458519867314
10.1016/j.jns.2018.06.001
10.1001/jama.2020.26858
10.1177/1352458518765656
10.1212/WNL.33.11.1444
10.1097/WCO.0000000000000701
10.1212/WNL.0000000000007035
10.1093/brain/awl007
10.1016/B978-0-444-52001-2.00014-5
10.1007/s00415-022-11341-2
10.1111/ene.14705
10.1111/ene.12690
10.1186/s12883-015-0296-2
ContentType Journal Article
Contributor Leist, Thomas
Xia, Zongqi
Lynch, Sharon
Amezcua, Lilyana
Goodman, Andrew
Kannan, Meena
Goldman, Myla
Racke, Michael
Berger, Joseph
Bourdette, Dennis
Sriram, Subramaniam
Bowen, James
Rammohan, Kottil
Fallis, Robert
Klawiter, Eric
Cross, Anne
Yadav, Vijayshree
Tornatore, Carlo
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References Rae-Grant, Day, Marrie (bib1) 2018; 90
Green, Kalina, Ford, Pandey, Kister (bib12) 2016; 24
Amezcua, Rivera, Vazquez, Baezconde-Garbanati, Langer-Gould (bib27) 2021; 78
Hua, Fan, Conway, Thompson, Kinzy (bib18) 2019; 25
Schweitzer, Laurent, Fink (bib4) 2019; 32
Rio, Rovira, Gasperini (bib19) 2022; 269
Yang, Hamade, Wu (bib29) 2022; 23
Hohol, Orav, Weiner (bib13) 1999; 5
Phillips, Wyrwich, Guo (bib15) 2014; 20
Roos, Malpas, Leray (bib22) 2022; 99
Signori, Schiavetti, Gallo, Sormani (bib7) 2015; 22
Bsteh, Hegen, Riedl (bib20) 2021; 28
Kister, Spelman, Patti (bib23) 2018; 391
McGinley, Cola, Fox, Cohen, Corboy, Miller (bib30) 2020; 26
Polman, Reingold, Banwell (bib9) 2011; 69
Avasarala (bib26) 2019; 24
Chappuis, Rousseau, Bajeux (bib25) 2023; 270
McGinley, Goldschmidt, Rae-Grant (bib2) 2021; 325
Lublin, Reingold, Cohen (bib6) 2014; 83
Marrie, Goldman (bib14) 2007; 13
Confavreux, Vukusic (bib5) 2006; 129
López-Góngora, Querol, Escartín (bib16) 2015; 15
Birnbaum (bib17) 2017; 19
Wallin, Culpepper, Campbell (bib3) 2019; 92
Kurtzke (bib10) 1983; 33
Yano, Gonzalez, Healy, Glanz, Weiner, Chitnis (bib24) 2019; 35
National Institute of Neurological Disorders and Stroke. User Manual for the Quality of Life in Neurological Disorders (Neuro-QoL) Measures, Version 2.0, March 2015.
Talwar, Earla, Hutton, Aparasu (bib28) 2022; 57
Confavreux, Vukusic (bib21) 2014; 122
Tremlett, Zhao, Joseph, Devonshire (bib8) 2008; 79
Avasarala (10.1016/S1474-4422(23)00154-0_bib26) 2019; 24
Yang (10.1016/S1474-4422(23)00154-0_bib29) 2022; 23
Polman (10.1016/S1474-4422(23)00154-0_bib9) 2011; 69
Birnbaum (10.1016/S1474-4422(23)00154-0_bib17) 2017; 19
López-Góngora (10.1016/S1474-4422(23)00154-0_bib16) 2015; 15
Amezcua (10.1016/S1474-4422(23)00154-0_bib27) 2021; 78
Confavreux (10.1016/S1474-4422(23)00154-0_bib21) 2014; 122
Hohol (10.1016/S1474-4422(23)00154-0_bib13) 1999; 5
Marrie (10.1016/S1474-4422(23)00154-0_bib14) 2007; 13
Yano (10.1016/S1474-4422(23)00154-0_bib24) 2019; 35
Phillips (10.1016/S1474-4422(23)00154-0_bib15) 2014; 20
McGinley (10.1016/S1474-4422(23)00154-0_bib2) 2021; 325
McGinley (10.1016/S1474-4422(23)00154-0_bib30) 2020; 26
Roos (10.1016/S1474-4422(23)00154-0_bib22) 2022; 99
Schweitzer (10.1016/S1474-4422(23)00154-0_bib4) 2019; 32
Chappuis (10.1016/S1474-4422(23)00154-0_bib25) 2023; 270
Tremlett (10.1016/S1474-4422(23)00154-0_bib8) 2008; 79
Kurtzke (10.1016/S1474-4422(23)00154-0_bib10) 1983; 33
Confavreux (10.1016/S1474-4422(23)00154-0_bib5) 2006; 129
Wallin (10.1016/S1474-4422(23)00154-0_bib3) 2019; 92
Talwar (10.1016/S1474-4422(23)00154-0_bib28) 2022; 57
10.1016/S1474-4422(23)00154-0_bib11
Lublin (10.1016/S1474-4422(23)00154-0_bib6) 2014; 83
Rio (10.1016/S1474-4422(23)00154-0_bib19) 2022; 269
Bsteh (10.1016/S1474-4422(23)00154-0_bib20) 2021; 28
Green (10.1016/S1474-4422(23)00154-0_bib12) 2016; 24
Hua (10.1016/S1474-4422(23)00154-0_bib18) 2019; 25
Kister (10.1016/S1474-4422(23)00154-0_bib23) 2018; 391
Signori (10.1016/S1474-4422(23)00154-0_bib7) 2015; 22
Rae-Grant (10.1016/S1474-4422(23)00154-0_bib1) 2018; 90
37353269 - Lancet Neurol. 2023 Jul;22(7):543-545
References_xml – volume: 90
  start-page: 777
  year: 2018
  end-page: 788
  ident: bib1
  article-title: Practice guideline recommendations summary: Disease-modifying therapies for adults with multiple sclerosis: report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology
  publication-title: Neurology
– volume: 25
  start-page: 699
  year: 2019
  end-page: 708
  ident: bib18
  article-title: Discontinuation of disease-modifying therapy in patients with multiple sclerosis over age 60
  publication-title: Mult Scler
– volume: 57
  year: 2022
  ident: bib28
  article-title: Prescribing of disease modifying agents in older adults with multiple sclerosis
  publication-title: Mult Scler Relat Disord
– volume: 28
  start-page: 1609
  year: 2021
  end-page: 1616
  ident: bib20
  article-title: Quantifying the risk of disease reactivation after interferon and glatiramer acetate discontinuation in multiple sclerosis: the VIAADISC score
  publication-title: Eur J Neurol
– volume: 33
  start-page: 1444
  year: 1983
  end-page: 1452
  ident: bib10
  article-title: Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS)
  publication-title: Neurology
– volume: 19
  start-page: 11
  year: 2017
  end-page: 14
  ident: bib17
  article-title: Stopping disease-modifying therapy in nonrelapsing multiple sclerosis: experience from a clinical practice
  publication-title: Int J MS Care
– volume: 24
  start-page: 183
  year: 2016
  end-page: 189
  ident: bib12
  article-title: SymptoMScreen: a tool for rapid assessment of symptom severity in MS across multiple domains
  publication-title: Appl Neurosychol Adult
– volume: 325
  start-page: 765
  year: 2021
  end-page: 779
  ident: bib2
  article-title: Diagnosis and treatment of multiple sclerosis: a review
  publication-title: JAMA
– volume: 20
  start-page: 1753
  year: 2014
  end-page: 1760
  ident: bib15
  article-title: Responder definition of the Multiple Sclerosis Impact Scale physical impact subscale for patients with physical worsening
  publication-title: Mult Scler J
– volume: 13
  start-page: 1176
  year: 2007
  end-page: 1182
  ident: bib14
  article-title: Validity of performance scales for disability assessment in multiple sclerosis
  publication-title: Mult Scler
– volume: 78
  start-page: 1515
  year: 2021
  end-page: 1524
  ident: bib27
  article-title: Health disparities, inequities, and social determinants of health in multiple sclerosis and related disorders in the US: a review
  publication-title: JAMA Neurol
– volume: 92
  start-page: e1029
  year: 2019
  end-page: e1040
  ident: bib3
  article-title: The prevalence of MS in the United States: a population-based estimate using health claims data
  publication-title: Neurology
– volume: 270
  start-page: 413
  year: 2023
  end-page: 422
  ident: bib25
  article-title: Discontinuation of second- versus first-line disease-modifying treatment in middle-aged patients with multiple sclerosis
  publication-title: J Neurol
– volume: 26
  start-page: 1581
  year: 2020
  end-page: 1589
  ident: bib30
  article-title: Perspectives of individuals with multiple sclerosis on discontinuation of disease-modifying therapies
  publication-title: Mult Scler
– volume: 24
  start-page: 279
  year: 2019
  end-page: 280
  ident: bib26
  article-title: FDA-approved drugs for multiple sclerosis have no efficacy or disability data in non-Caucasian patients
  publication-title: CNS Spectr
– volume: 129
  start-page: 606
  year: 2006
  end-page: 616
  ident: bib5
  article-title: Natural history of multiple sclerosis: a unifying concept
  publication-title: Brain
– volume: 83
  start-page: 278
  year: 2014
  end-page: 286
  ident: bib6
  article-title: Defining the clinical course of multiple sclerosis: the 2013 revisions
  publication-title: Neurology
– volume: 5
  start-page: 349
  year: 1999
  end-page: 354
  ident: bib13
  article-title: Disease steps in multiple sclerosis: a longitudinal study comparing disease steps and EDSS to evaluate disease progression
  publication-title: Mult Scler
– volume: 32
  start-page: 305
  year: 2019
  end-page: 312
  ident: bib4
  article-title: Age and the risks of high-efficacy disease modifying drugs in multiple sclerosis
  publication-title: Curr Opin Neurol
– reference: National Institute of Neurological Disorders and Stroke. User Manual for the Quality of Life in Neurological Disorders (Neuro-QoL) Measures, Version 2.0, March 2015.
– volume: 15
  start-page: 40
  year: 2015
  ident: bib16
  article-title: A one-year follow-up study of the Symbol Digit Modalities Test (SDMT) and the Paced Auditory Serial Addition Test (PASAT) in relapsing-remitting multiple sclerosis: an appraisal of comparative longitudinal sensitivity
  publication-title: BMC Neurol
– volume: 269
  start-page: 452
  year: 2022
  end-page: 459
  ident: bib19
  article-title: Treatment response scoring systems to assess long-term prognosis in self-injectable DMTs relapsing-remitting multiple sclerosis patients
  publication-title: J Neurol
– volume: 391
  start-page: 72
  year: 2018
  end-page: 76
  ident: bib23
  article-title: Predictors of relapse and disability progression in MS patients who discontinue disease-modifying therapy
  publication-title: J Neurol Sci
– volume: 23
  year: 2022
  ident: bib29
  article-title: Current and future biomarkers in multiple sclerosis
  publication-title: Int J Mol Sci
– volume: 79
  start-page: 1368
  year: 2008
  end-page: 1374
  ident: bib8
  article-title: Relapses in multiple sclerosis are age- and time-dependent
  publication-title: J Neurol Neurosurg Psychiatry
– volume: 69
  start-page: 292
  year: 2011
  end-page: 302
  ident: bib9
  article-title: Diagnostic criteria for multiple sclerosis: 2010 revisions to the McDonald criteria
  publication-title: Ann Neurol
– volume: 122
  start-page: 343
  year: 2014
  end-page: 369
  ident: bib21
  article-title: The clinical course of multiple sclerosis
  publication-title: Handb Clin Neurol
– volume: 99
  start-page: e1926
  year: 2022
  end-page: e1944
  ident: bib22
  article-title: Disease reactivation after cessation of disease-modifying therapy in patients with relapsing-remitting multiple sclerosis
  publication-title: Neurology
– volume: 22
  start-page: 960
  year: 2015
  end-page: 966
  ident: bib7
  article-title: Subgroups of multiple sclerosis patients with larger treatment benefits: a meta-analysis of randomized trials
  publication-title: Eur J Neurol
– volume: 35
  start-page: 119
  year: 2019
  end-page: 127
  ident: bib24
  article-title: Discontinuation of disease-modifying therapy for patients with relapsing-remitting multiple sclerosis: Effect on clinical and MRI outcomes
  publication-title: Mult Scler Relat Disord
– volume: 79
  start-page: 1368
  year: 2008
  ident: 10.1016/S1474-4422(23)00154-0_bib8
  article-title: Relapses in multiple sclerosis are age- and time-dependent
  publication-title: J Neurol Neurosurg Psychiatry
  doi: 10.1136/jnnp.2008.145805
– volume: 13
  start-page: 1176
  year: 2007
  ident: 10.1016/S1474-4422(23)00154-0_bib14
  article-title: Validity of performance scales for disability assessment in multiple sclerosis
  publication-title: Mult Scler
  doi: 10.1177/1352458507078388
– volume: 19
  start-page: 11
  year: 2017
  ident: 10.1016/S1474-4422(23)00154-0_bib17
  article-title: Stopping disease-modifying therapy in nonrelapsing multiple sclerosis: experience from a clinical practice
  publication-title: Int J MS Care
  doi: 10.7224/1537-2073.2015-032
– volume: 5
  start-page: 349
  year: 1999
  ident: 10.1016/S1474-4422(23)00154-0_bib13
  article-title: Disease steps in multiple sclerosis: a longitudinal study comparing disease steps and EDSS to evaluate disease progression
  publication-title: Mult Scler
  doi: 10.1177/135245859900500508
– volume: 83
  start-page: 278
  year: 2014
  ident: 10.1016/S1474-4422(23)00154-0_bib6
  article-title: Defining the clinical course of multiple sclerosis: the 2013 revisions
  publication-title: Neurology
  doi: 10.1212/WNL.0000000000000560
– volume: 69
  start-page: 292
  year: 2011
  ident: 10.1016/S1474-4422(23)00154-0_bib9
  article-title: Diagnostic criteria for multiple sclerosis: 2010 revisions to the McDonald criteria
  publication-title: Ann Neurol
  doi: 10.1002/ana.22366
– volume: 20
  start-page: 1753
  year: 2014
  ident: 10.1016/S1474-4422(23)00154-0_bib15
  article-title: Responder definition of the Multiple Sclerosis Impact Scale physical impact subscale for patients with physical worsening
  publication-title: Mult Scler J
  doi: 10.1177/1352458514530489
– volume: 269
  start-page: 452
  year: 2022
  ident: 10.1016/S1474-4422(23)00154-0_bib19
  article-title: Treatment response scoring systems to assess long-term prognosis in self-injectable DMTs relapsing-remitting multiple sclerosis patients
  publication-title: J Neurol
  doi: 10.1007/s00415-021-10823-z
– volume: 24
  start-page: 279
  year: 2019
  ident: 10.1016/S1474-4422(23)00154-0_bib26
  article-title: FDA-approved drugs for multiple sclerosis have no efficacy or disability data in non-Caucasian patients
  publication-title: CNS Spectr
  doi: 10.1017/S1092852918001517
– volume: 24
  start-page: 183
  year: 2016
  ident: 10.1016/S1474-4422(23)00154-0_bib12
  article-title: SymptoMScreen: a tool for rapid assessment of symptom severity in MS across multiple domains
  publication-title: Appl Neurosychol Adult
  doi: 10.1080/23279095.2015.1125905
– volume: 99
  start-page: e1926
  year: 2022
  ident: 10.1016/S1474-4422(23)00154-0_bib22
  article-title: Disease reactivation after cessation of disease-modifying therapy in patients with relapsing-remitting multiple sclerosis
  publication-title: Neurology
  doi: 10.1212/WNL.0000000000201029
– volume: 78
  start-page: 1515
  year: 2021
  ident: 10.1016/S1474-4422(23)00154-0_bib27
  article-title: Health disparities, inequities, and social determinants of health in multiple sclerosis and related disorders in the US: a review
  publication-title: JAMA Neurol
  doi: 10.1001/jamaneurol.2021.3416
– volume: 90
  start-page: 777
  year: 2018
  ident: 10.1016/S1474-4422(23)00154-0_bib1
  article-title: Practice guideline recommendations summary: Disease-modifying therapies for adults with multiple sclerosis: report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology
  publication-title: Neurology
  doi: 10.1212/WNL.0000000000005347
– ident: 10.1016/S1474-4422(23)00154-0_bib11
– volume: 57
  year: 2022
  ident: 10.1016/S1474-4422(23)00154-0_bib28
  article-title: Prescribing of disease modifying agents in older adults with multiple sclerosis
  publication-title: Mult Scler Relat Disord
  doi: 10.1016/j.msard.2021.103308
– volume: 35
  start-page: 119
  year: 2019
  ident: 10.1016/S1474-4422(23)00154-0_bib24
  article-title: Discontinuation of disease-modifying therapy for patients with relapsing-remitting multiple sclerosis: Effect on clinical and MRI outcomes
  publication-title: Mult Scler Relat Disord
  doi: 10.1016/j.msard.2019.07.021
– volume: 26
  start-page: 1581
  year: 2020
  ident: 10.1016/S1474-4422(23)00154-0_bib30
  article-title: Perspectives of individuals with multiple sclerosis on discontinuation of disease-modifying therapies
  publication-title: Mult Scler
  doi: 10.1177/1352458519867314
– volume: 391
  start-page: 72
  year: 2018
  ident: 10.1016/S1474-4422(23)00154-0_bib23
  article-title: Predictors of relapse and disability progression in MS patients who discontinue disease-modifying therapy
  publication-title: J Neurol Sci
  doi: 10.1016/j.jns.2018.06.001
– volume: 325
  start-page: 765
  year: 2021
  ident: 10.1016/S1474-4422(23)00154-0_bib2
  article-title: Diagnosis and treatment of multiple sclerosis: a review
  publication-title: JAMA
  doi: 10.1001/jama.2020.26858
– volume: 25
  start-page: 699
  year: 2019
  ident: 10.1016/S1474-4422(23)00154-0_bib18
  article-title: Discontinuation of disease-modifying therapy in patients with multiple sclerosis over age 60
  publication-title: Mult Scler
  doi: 10.1177/1352458518765656
– volume: 33
  start-page: 1444
  year: 1983
  ident: 10.1016/S1474-4422(23)00154-0_bib10
  article-title: Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS)
  publication-title: Neurology
  doi: 10.1212/WNL.33.11.1444
– volume: 32
  start-page: 305
  year: 2019
  ident: 10.1016/S1474-4422(23)00154-0_bib4
  article-title: Age and the risks of high-efficacy disease modifying drugs in multiple sclerosis
  publication-title: Curr Opin Neurol
  doi: 10.1097/WCO.0000000000000701
– volume: 92
  start-page: e1029
  year: 2019
  ident: 10.1016/S1474-4422(23)00154-0_bib3
  article-title: The prevalence of MS in the United States: a population-based estimate using health claims data
  publication-title: Neurology
  doi: 10.1212/WNL.0000000000007035
– volume: 129
  start-page: 606
  year: 2006
  ident: 10.1016/S1474-4422(23)00154-0_bib5
  article-title: Natural history of multiple sclerosis: a unifying concept
  publication-title: Brain
  doi: 10.1093/brain/awl007
– volume: 23
  year: 2022
  ident: 10.1016/S1474-4422(23)00154-0_bib29
  article-title: Current and future biomarkers in multiple sclerosis
  publication-title: Int J Mol Sci
– volume: 122
  start-page: 343
  year: 2014
  ident: 10.1016/S1474-4422(23)00154-0_bib21
  article-title: The clinical course of multiple sclerosis
  publication-title: Handb Clin Neurol
  doi: 10.1016/B978-0-444-52001-2.00014-5
– volume: 270
  start-page: 413
  year: 2023
  ident: 10.1016/S1474-4422(23)00154-0_bib25
  article-title: Discontinuation of second- versus first-line disease-modifying treatment in middle-aged patients with multiple sclerosis
  publication-title: J Neurol
  doi: 10.1007/s00415-022-11341-2
– volume: 28
  start-page: 1609
  year: 2021
  ident: 10.1016/S1474-4422(23)00154-0_bib20
  article-title: Quantifying the risk of disease reactivation after interferon and glatiramer acetate discontinuation in multiple sclerosis: the VIAADISC score
  publication-title: Eur J Neurol
  doi: 10.1111/ene.14705
– volume: 22
  start-page: 960
  year: 2015
  ident: 10.1016/S1474-4422(23)00154-0_bib7
  article-title: Subgroups of multiple sclerosis patients with larger treatment benefits: a meta-analysis of randomized trials
  publication-title: Eur J Neurol
  doi: 10.1111/ene.12690
– volume: 15
  start-page: 40
  year: 2015
  ident: 10.1016/S1474-4422(23)00154-0_bib16
  article-title: A one-year follow-up study of the Symbol Digit Modalities Test (SDMT) and the Paced Auditory Serial Addition Test (PASAT) in relapsing-remitting multiple sclerosis: an appraisal of comparative longitudinal sensitivity
  publication-title: BMC Neurol
  doi: 10.1186/s12883-015-0296-2
– reference: 37353269 - Lancet Neurol. 2023 Jul;22(7):543-545
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Snippet Multiple sclerosis typically has onset in young adults and new disease activity diminishes with age. Most clinical trials of disease-modifying therapies for...
Summary Background Multiple sclerosis typically has onset in young adults and new disease activity diminishes with age. Most clinical trials of...
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SubjectTerms Adverse events
Age
Aged
Clinical trials
Disability
Double-Blind Method
FDA approval
Humans
Lesions
Magnetic Resonance Imaging
Multiple sclerosis
Multiple Sclerosis - diagnostic imaging
Multiple Sclerosis - drug therapy
Neuroimaging
Observational studies
Patients
Risk assessment
Single-Blind Method
Treatment Outcome
Young Adult
Young adults
Title Risk of new disease activity in patients with multiple sclerosis who continue or discontinue disease-modifying therapies (DISCOMS): a multicentre, randomised, single-blind, phase 4, non-inferiority trial
URI https://www.clinicalkey.com/#!/content/1-s2.0-S1474442223001540
https://dx.doi.org/10.1016/S1474-4422(23)00154-0
https://www.ncbi.nlm.nih.gov/pubmed/37353277
https://www.proquest.com/docview/2828347058
https://www.proquest.com/docview/2829424571
Volume 22
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