Multiple sclerosis and related disorders · 2026
DIscontinuation of disease-modifying therapies in older adults with multiple sclerosis.
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Li Jieni, Hutton George J, Aparasu Rajender R
Аннотация
BACKGROUND: Disease-modifying therapy (DMT) use in older adults with multiple sclerosis (MS) is debated due to age-related factors, effectiveness, and economic concerns of DMTs. Therefore, this study examined the factors influencing the discontinuation of DMTs in older adults with MS.
METHODS: This retrospective cohort study included Medicare beneficiaries (≥66 years) with MS who are persistent DMT users. Discontinuation of DMT was defined as ≥12 consecutive months without DMT use, while continuation of DMT was defined as maintaining Proportion of Days Covered ≥80% for an additional 24 months. A multivariable logistic regression was used to identify the baseline factors associated with DMT discontinuation.
RESULTS: Among 8,694 eligible aged Medicare beneficiaries with persistent DMT use, 1,025 (11.79%) discontinued DMTs. The discontinuation cohort had a mean age of 69.7 ± 3.9 years, with 79.5% females and 91.1% Whites. Older age, recent years, and clinical complexity, such as frailty and disability, were associated with lower odds of discontinuation. However, patients with dual eligibility and certain comorbidities were more likely to discontinue therapy.
CONCLUSIONS: Among older MS patients with persistent DMT use, about 12% discontinued, with significant sociodemographic and clinical characteristics influencing DMT discontinuation. Evaluation of the outcomes of DMT discontinuation is warranted to inform treatment decisions and enhance geriatric MS care.
METHODS: This retrospective cohort study included Medicare beneficiaries (≥66 years) with MS who are persistent DMT users. Discontinuation of DMT was defined as ≥12 consecutive months without DMT use, while continuation of DMT was defined as maintaining Proportion of Days Covered ≥80% for an additional 24 months. A multivariable logistic regression was used to identify the baseline factors associated with DMT discontinuation.
RESULTS: Among 8,694 eligible aged Medicare beneficiaries with persistent DMT use, 1,025 (11.79%) discontinued DMTs. The discontinuation cohort had a mean age of 69.7 ± 3.9 years, with 79.5% females and 91.1% Whites. Older age, recent years, and clinical complexity, such as frailty and disability, were associated with lower odds of discontinuation. However, patients with dual eligibility and certain comorbidities were more likely to discontinue therapy.
CONCLUSIONS: Among older MS patients with persistent DMT use, about 12% discontinued, with significant sociodemographic and clinical characteristics influencing DMT discontinuation. Evaluation of the outcomes of DMT discontinuation is warranted to inform treatment decisions and enhance geriatric MS care.