Age-related differences in switching highly effective disease-modifying therapy in patients with multiple sclerosis.

Background: High efficacy therapies (HET) play a crucial role in multiple sclerosis (MS) management. HET discontinuation/de-escalation is a critical decision, especially in different age groups, due to potential changes in relapse rates. We aimed at evaluating the impact of HET discontinuation on annualized relapse rates (ARRs) in people with MS (pwMS) aged ≥ 50 or < 50 years.

Methods: We retrospectively analyzed data of 1,091 pwMS (German MS Register). ARR before and 12 months after the HET washout period were compared between older and younger patients for switching from HET to HET (H-H), HET to mild/moderate efficacy therapies (H-M) or HET to discontinuation (H-D). Reasons for therapy switches were assessed for all subgroups.

Results: Most treatment switches continued with another HET (H-H n = 786), while de-escalation (H-M n = 86) or discontinuation (H-D n = 219) occurred less frequently. The minority within each switching group were ≥ 50 years of age (H-H 29%, H-M 22%, H-D 32%). ARR in H-H decreased after switching in both age groups (< 50: 0.19-0.12; ≥ 50: 0.17 to 0.09), increased in H-M < 50 (0.13-0.63) and remained stable in ≥ 50 (0.11-0.08), and increased in H-D < 50 (0.05-0.13) and remained stable in ≥ 50 (0.14-0.11). Main reason for therapy switch was lack of efficacy in H-H, adverse events in H-M regardless of age, patient's choice (23%) in H-D < 50, and lack of efficacy (26%) in H-D ≥ 50.

Conclusions: Discontinuation strategies should be individualized, considering age-related changes in disease activity, adverse events and patient's choice.