Neurologists Support DMT Use in Older Patients With Multiple Sclerosis, Survey Shows

Flavia Nelson, MD

In a survey of Members of the Medical Partnership 4 MS+ (MP4MS+), a group of more than 1300 neurologists, a large majority of respondents agreed that disability, age, and ambulation should not preclude disease-modifying therapy (DMT) use in older patients with multiple sclerosis (MS). Overall, most neurologist felt that individualized assessment, rather than age-based rules, should be applied when considering DMT discontinuation following long-term stability.

These data were presented as a late-breaking poster at the 2025 Consortium of Multiple Sclerosis Centers (CMSC) Annual Meeting, held May 28-31, in Phoenix, Arizona, by Flavia Nelson, MD, director of the National Multiple Sclerosis Center of Excellence at the University of Miami. The survey, anonymously sent to members of MP4MS+ from June 2024 to February 2025, explored neurologists’ attitudes towards DMT benefits in older patients, disability influence on treatment, risk of relapse after discontinuation, and criteria for considering discontinuation.

Among the 341 respondents, 87.1% claimed there is no "age rule" on whether older patients should discontinue DMT because "patients are different." In addition, 64.51% felt that having high disability does not play a role in discontinuation because the “goal of treatment is preservation of function for as long as possible.” This was in line with clear agreement among prescribers that disability level should not be used by payors as a reason for discontinuation.

The question of whether to discontinue DMTs in older patients with MS–particularly those with stable disease–has become an area of active debate in the MS community. This debate is shaped by a growing population of aging patients with MS, the long-term risks and costs of DMTs, and evolving data on disease activity in older individuals.

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In the research, 87.1% of neurologist responders agreed with scientific evidence that older patients with MS relapse, even after long-term stability. In contrast to the 5 years of stability studied in recent trials like DISCOMS, 50% of respondents felt that discontinuation should only be considered after 10 years of stability. Furthermore, 77.7% of neurologists claimed they do not tell their stable patients to discontinue, and 25% of those discuss it only after being raised by the patient/care partner, consistent with patient-centered decision-making.

There are a number of reasons for why clinicians may favor continued DMT use in older patients, including the fear of rebound disease activity, individual variability, and psychological comfort. In addition, clinicians may have subtle progression concerns, as MS can progress insidiously. Notably, while data is emerging, there is not strong consensus of universal protocol for how and when to discontinue DMTs, leading many clinicians to err on the side of caution.

The DISCOMS trial, published in Lancet Neurology in 2022, provided evidence that it may be safe to discontinue DMTs in older, stable patients. This phase 4, non-inferiority trial included 259 patients with any subtype of MS, aged 55 years or older, with no relapse within the past 5 years or new MRI lesion in the past 3 years while continuously taking an approved DMT. In the trial, patients were randomly assigned 1:1 with an interactive response technology system to either continue (n = 128) or discontinue (n = 131) DMT.²

Overall, 6 (4.7%) of the 128 participants in the continue group and 16 (12.2%) of the 131 in the 131 in the discontinue group had a relapse or a new expanding brain MRI lesion within 2 years. Investigators concluded that they were unable to reject the null hypothesis and could not conclude whether DMT discontinuation is non-inferior to continuation in patients older than 55 years with MS and no recent relapse or new MRI activity. One participant in the continue group and 2 in the discontinue group died, although no deaths were deemed related to treatment. The study authors noted that discontinuation of DMT in stable patients may be a reasonable option, but also might be associated with a small increased risk of new MRI activity.

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REFERENCES
1. Nelson F, Ross AP, Berkovich R, et al. LBA13 - Dmt (disease modifying therapy) Role in the Ageing MS (multiple sclerosis) Population: Neurologist Survey. Presented at: 2025 CMSC Annual Meeting; May 28-31; Phoenix, Arizona. ABSTRACT LBA13
2. Corboy JR, Fox RJ, Kister I, et al. Risk of new disease activity in patients with multiple sclerosis who continue or discontinue disease-modifying therapies (DISCOMS): a multicentre, randomised, single-blind, phase 4, non-inferiority trial. Lancet Neurol. 2023;22(7):568-577. doi:10.1016/S1474-4422(23)00154-0