Patients older than 55 years with relapsing multiple sclerosis after drug discontinuation – a Brazilian single-center cohort

Introduction: The risk-benefit profile of disease modifying therapy use in older people living with multiple sclerosis is not well documented due to most pivotal studies having limited the age of enrolment at 55 years. Furthermore, drug side effects along with imunosenescence may multiply the risk of health complications. Objective: To identify characteristics associated to success after DMT discontinuation in a single center. Methods: We conducted a retrospective observational study with real life data based on medical records. We identified 62 RRMS patients older than 55 years who had previous DMT use, 17 of them had DMT discontinuation by any cause. Results: Fifteen patients achieved NEDA after a minimum follow up of 12 months (mean 56 months). Two had drug stopped last appointment. The mean and SD age at DMT withdrawal was 56.8 (5.7) years. It was injectable in fifteen (88%) patients. Four (23%) had only one relapse in the disease course. The mean EDSS score at last outpatient evaluation was 2.8 (1.8) points. In the followed up group, stopping DMT before or after 55 years did not lead to differences in measured EDSS. Thirteen (87%) did not have coalescent lesions in prior MRI and none had radiologic or clinic activity in the last 8.5 (4.7) years of disease. Six patients (35%) were in reposition of vitamin D and five (29%) had present or past tobacco use. The most prevalent comorbidity in this group was psychiatric disorders (10, 59%), followed by hypertension and dyslipidemia (7, 41% for each one) and thyroid dysfunction (5, 29%). Conclusion: DMT discontinuation did not lead to new relapse activity or measured progression in our cohort. The absence of patients with active relapse impeded the assessment of factors that may be associated with success or failure of DMT withdrawal.