Monschein Tobias, Salhofer-Polanyi Sabine, Altmann Patrick, Zrzavy Tobias, Dal-Bianco Assunta, Bsteh Gabriel, Rommer Paulus, Berger Thomas, Leutmezer Fritz
Medizinische Universitat Wien, Wien, Austria.
J Neurol. 2021 Apr;268(4):1247-1253. doi: 10.1007/s00415-020-10074-4. Epub 2020 Sep 14.
Treatment with disease-modifying therapies (DMT) in patients with clinically isolated syndrome (CIS) represents standard care in multiple sclerosis (MS) patients nowadays. Since a proportion of patients may show no evidence of disease activity (NEDA) after some time of treatment, the question might arise about the risks of stopping DMT.
We present a cohort of 49 patients who started DMT immediately after CIS and had no evidence of disease activity (NEDA-3) for at least five years before discontinuation of therapy. Thereafter, patients underwent clinical and MRI follow-up for at least five consecutive years.
Of 49 patients discontinuing DMT, 53% (n = 26) had NEDA for at least further five years, while 47% (n = 23) showed either a relapse/disease progression (18.4%, n = 9), MRI activity (14.3%, n = 7) or both (14.3%, n = 7). The main predictive factor for sustained NEDA was age at DMT termination. Patients aged > 45 years had a significantly lower risk of disease reactivation (13% vs. 54% in patients aged < 45 years, p < 0.001) after DMT discontinuation.
In CIS patients with immediate DMT after their first clinical episode, older age at the time of DMT discontinuation is the main predictive factor for sustained NEDA status.
如今，对临床孤立综合征（CIS）患者使用疾病修正疗法（DMT）进行治疗是多发性硬化症（MS）患者的标准治疗方法。由于一部分患者在经过一段时间的治疗后可能没有疾病活动的迹象（NEDA），因此可能会出现关于停用DMT的风险问题。
我们报告了一组49例患者，他们在CIS后立即开始使用DMT，并且在停药前至少五年没有疾病活动的证据（NEDA-3）。此后，患者接受了至少连续五年的临床和MRI随访。
在49例停用DMT的患者中，53%（n = 26）至少在接下来的五年中保持NEDA状态，而47%（n = 23）出现了复发/疾病进展（18.4%，n = 9）、MRI活动（14.3%，n = 7）或两者兼有（14.3%，n = 7）。持续NEDA的主要预测因素是DMT停药时的年龄。DMT停药后，年龄>45岁的患者疾病重新激活的风险显著较低（13%对<45岁患者的54%，p<0.001）。
在首次临床发作后立即接受DMT治疗的CIS患者中，DMT停药时年龄较大是持续NEDA状态的主要预测因素。
