Evolution of Disease Modifying Therapy Benefits and Risks: An Argument for De-escalation as a Treatment Paradigm for Patients With Multiple Sclerosis.

ABSTRACT:

Background

Strategies for sequencing disease modifying therapies (DMTs) in multiple sclerosis (MS) patients include escalation, high efficacy early, induction, and de-escalation.

Objective

To provide a perspective on de-escalation, which aims to match the ratio of DMT benefit/risk in aging patients.

Methods

We reanalyzed data from a retrospective, real-world cohort of MS patients to model disease activity for oral (dimethyl fumarate and fingolimod) and higher efficacy infusible (natalizumab and rituximab) DMTs by age. For patients with relapsing MS, we conducted a controlled, stratified analysis examining odds of disease activity for oral vs. infusible DMTs in patients <45 or ≥45 years. We reviewed the literature to identify DMT risks and predictors of safe discontinu

SUBMITTER: Vollmer BL 

PROVIDER: S-EPMC8821102 | biostudies-literature | 2021

REPOSITORIES: biostudies-literature