Strategic De-escalation of Disease-Modifying Therapies in Elderly Patients: Approaches and Considerations

This review presents a summary of the literature on de-escalation and discontinuation of disease-modifying therapies (DMTs) in multiple sclerosis (MS), especially as it relates to the aging patient.

Currently available DMTs may have less benefit in people with MS who are older, stable and have received years of treatment. Observational studies and interventional trials in people with MS who de-escalate or discontinue their DMTs have demonstrated varied outcomes over the short- to medium-term. Certain factors such as a person’s age, type of DMT, length of treatment, and recent presence of disease activity influence the likelihood of MS activity following discontinuation or de-escalation.

Much work remains to be able to accurately predict when it is safe and appropriate for an individual with MS to discontinue or de-escalate from DMTs, though current research has narrowed down the window at which providers should begin to consider these issues.