This article reviews the reasons for discontinuation or switching of multiple sclerosis disease-modifying therapy as well as procedures that might mitigate risk to the patient under such circumstances.
Recent review of the literature, as well as the author’s extensive clinical experience, indicate that the discontinuation of multiple sclerosis disease-modifying therapies occurs for many reasons. Often one medication is stopped at the recommendation of the physician in order to switch to another medication. However, often the decision to discontinue medication is made by the patient. Unfortunately, in still other situations, treatment is stopped because of circumstances beyond the control of either patient or physician (eg, a loss of insurance coverage). Currently available data do not permit a conclusion about whether it is ever safe to discontinue disease-modifying therapy in a stable patient without the expectation of return of disease activity.
Clinicians must help patients avoid unnecessary and undesirable cessation of disease-modifying therapy. While switches of therapy are often necessary, steps to minimize both adverse events and the risk of recurrent disease should be undertaken. Whether disease-modifying therapy can ever be purposely discontinued without incurring a significant risk of disease recurrence remains to be determined.
Address correspondence to Dr Aaron E. Miller, 5 E 98th St, Box 1138, New York, NY 10029, firstname.lastname@example.org.
Relationship Disclosure: Dr Miller serves as editor of Continuum Audio and as a consultant for Accordant; Acorda Therapeutics; Alkermes; Biogen; EMD Serono, Inc; Genentech Inc; GlaxoSmithKline; Mallinckrodt Pharmaceuticals; Novartis AG; and Sanofi Genzyme. Dr Miller has received personal compensation for speaking engagements from Biogen and Genentech Inc, and research support from Biogen, Genentech Inc, Mallinckrodt Pharmaceuticals, Novartis AG, and Sanofi Genzyme. Dr Miller has provided expert legal testimony on the diagnosis and management of multiple sclerosis.
Unlabeled Use of Products/Investigational Use Disclosure: Dr Miller reports no disclosure.