Ellenberger David, Frahm Niklas, Stahmann Alexander, Warnke Clemens, Hellwig Kerstin, Kleinschnitz Christoph, Flachenecker Peter, Mai Michaela, Grothe Matthias, Zettl Uwe K
German MS Register, MS Forschungs- und Projektentwicklungs- gGmbH (MS Research and Project Development gGmbH [MSFP]), Krausenstr. 50, 30171, Hannover, Germany.
Department of Neurology, University Hospital of Gießen and Marburg, Marburg, Germany.
J Neurol. 2025 Sep 4;272(9):609. doi: 10.1007/s00415-025-13330-7.
High efficacy therapies (HET) play a crucial role in multiple sclerosis (MS) management. HET discontinuation/de-escalation is a critical decision, especially in different age groups, due to potential changes in relapse rates. We aimed at evaluating the impact of HET discontinuation on annualized relapse rates (ARRs) in people with MS (pwMS) aged ≥ 50 or < 50 years.
We retrospectively analyzed data of 1,091 pwMS (German MS Register). ARR before and 12 months after the HET washout period were compared between older and younger patients for switching from HET to HET (H-H), HET to mild/moderate efficacy therapies (H-M) or HET to discontinuation (H-D). Reasons for therapy switches were assessed for all subgroups.
Most treatment switches continued with another HET (H-H n = 786), while de-escalation (H-M n = 86) or discontinuation (H-D n = 219) occurred less frequently. The minority within each switching group were ≥ 50 years of age (H-H 29%, H-M 22%, H-D 32%). ARR in H-H decreased after switching in both age groups (< 50: 0.19-0.12; ≥ 50: 0.17 to 0.09), increased in H-M < 50 (0.13-0.63) and remained stable in ≥ 50 (0.11-0.08), and increased in H-D < 50 (0.05-0.13) and remained stable in ≥ 50 (0.14-0.11). Main reason for therapy switch was lack of efficacy in H-H, adverse events in H-M regardless of age, patient's choice (23%) in H-D < 50, and lack of efficacy (26%) in H-D ≥ 50.
Discontinuation strategies should be individualized, considering age-related changes in disease activity, adverse events and patient's choice.
高效疗法（HET）在多发性硬化症（MS）管理中起着关键作用。由于复发率可能发生变化，尤其是在不同年龄组中，停用/降低HET剂量是一个关键决策。我们旨在评估停用HET对年龄≥50岁或<50岁的多发性硬化症患者（pwMS）年化复发率（ARR）的影响。
我们回顾性分析了1091例pwMS患者的数据（德国MS注册库）。比较了老年和年轻患者在从HET转换为HET（H-H）、从HET转换为中/低效疗法（H-M）或从HET停用（H-D）的HET洗脱期前后的ARR。评估了所有亚组治疗转换的原因。
大多数治疗转换继续使用另一种HET（H-H，n = 786），而降低剂量（H-M，n = 86）或停用（H-D，n = 219）的情况较少见。每个转换组中少数患者年龄≥50岁（H-H组为29%，H-M组为22%，H-D组为32%）。在两个年龄组中，H-H组转换后ARR均下降（<50岁：从0.19降至0.12；≥50岁：从0.17降至0.09），H-M组中<50岁患者的ARR升高（从0.13升至0.63），≥50岁患者的ARR保持稳定（从0.11降至0.08），H-D组中<50岁患者的ARR升高（从0.05升至0.13），≥50岁患者的ARR保持稳定（从0.14降至0.11）。治疗转换的主要原因在H-H组是疗效不佳，在H-M组是无论年龄的不良事件，在<50岁的H-D组是患者选择（23%），在≥50岁的H-D组是疗效不佳（26%）。
应根据疾病活动度、不良事件和患者选择的年龄相关变化，制定个体化的停药策略。
