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09.01.2020 | Original Research Article | Ausgabe 3/2020

Drugs & Aging 3/2020

Informing Medication Discontinuation Decisions among Older Adults with Relapsing-Onset Multiple Sclerosis

Drugs & Aging > Ausgabe 3/2020
Natalie A. Schwehr, Karen M. Kuntz, Eva A. Enns, Nathan D. Shippee, Elaine Kingwell, Helen Tremlett, Adam F. Carpenter, Mary Butler, The BeAMS Study group
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1007/​s40266-019-00741-1) contains supplementary material, which is available to authorized users.
Members of “The BeAMS Study group” are listed in the Acknowledgement section.



For older adults with relapsing-onset multiple sclerosis (MS), limited information is available to inform if, or when, disease-modifying drugs (DMDs) may be safely discontinued.


The aim of this study was to project the outcomes of DMD discontinuation among older adults with relapsing-onset MS.


We projected the 10-year outcomes of discontinuation of a DMD (interferon-β, fingolimod, or natalizumab) among older adults (aged 55 or 70 years) who were relapse-free for 5 or more years and had not reached an Expanded Disability Status Scale (EDSS) score of 6. Outcomes included the percentage of people who had at least one relapse or reached EDSS 6, and quality-adjusted life-years (QALYs), which incorporated both relapses and disability. We used a simulation modeling approach. With increased age, relapses decreased and the effectiveness of DMDs for disability outcomes also decreased.


We found lower projected benefits for DMD continuation at 70 years of age than at 55 years of age. Compared with discontinuation, the projected benefit of DMD continuation ranged from 0.007 to 0.017 QALYs at 55 years of age and dropped to 0.002–0.006 at 70 years of age. The annual projected benefits of DMD continuation (0.1–3.0 quality-adjusted life-days) were very low compared with typical patient preferences regarding treatment burden.


The benefits of DMDs may not be substantial among older adults with relapsing-onset MS. Direct clinical evidence remains limited and the decision of whether to discontinue a DMD should also take into account patient preferences. It is important to gain a better understanding of how age-related changes in the trajectory of relapsing-onset MS affect treatment effectiveness among older adults.

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