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Ozen NPA, Dursun EG, Tuncer A, Karabudak R. Navigating the discontinuation of multiple sclerosis first line treatments: A paradigm shift in patient care. Mult Scler Relat Disord 2024; 84:105503. [PMID: 38422633 DOI: 10.1016/j.msard.2024.105503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 02/09/2024] [Accepted: 02/12/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND This retrospective study, conducted between 2005 and 2016, investigated the outcomes of patients with multiple sclerosis (MS) who discontinued injectable first-line disease-modifying therapies (DMTs). The study aimed to identify factors influencing treatment discontinuation and assess the impact of discontinuation on disease progression. METHODS Data was collected from 2,270 patients who received injectable DMTs for at least two years and subsequently discontinued treatment due to clinical and MRI remission, side effects, or noncompliance. Patients were categorized into two groups: those stable after discontinuation (SAD) and those with relapse after discontinuation (RAD). Survival analysis and logistic regression were employed to assess factors influencing treatment discontinuation. RESULTS Of the 60 patients who discontinued DMTs, one-third (n = 20) remained stable, while 40 patients experienced clinical and/or MRI activity during follow-up. The SAD group had a significantly later age at treatment discontinuation compared to RAD patients (35.9 ± 11.1 vs. 30.7 ± 6.1, p = 0.025). Patients below 40 years old had a higher likelihood of experiencing worsening (75 %), while those over 50 years old demonstrated an 80 % stability rate. SAD patients used DMTs for a more extended period than RAD patients (69.1 ± 47.3 vs. 46.6 ± 20.3 months, p = 0.012). A notable proportion (42.9 %) of worsened patients discontinued DMTs without consulting a physician, emphasizing potential challenges in treatment adherence. After treatment discontinuation, RAD patients experienced relapses after a median of 21.0 months. Survival analysis suggested a more favorable disease course for patients who discontinued treatment after achieving a stable period (p = 0.237), with evidence of differentiation between groups after four years. Regression analysis indicated that older age at discontinuation had a favorable impact on relapse probability (HR: 0.904; p = 0.031; 95 % CI: 0.825, 0.991). Reasons for discontinuation unrelated to disease stability showed a positive but imprecise effect on relapse probability. CONCLUSION This study provides insights into the outcomes of MS patients discontinuing injectable DMTs, emphasizing the importance of age at discontinuation and reasons for treatment cessation in predicting disease progression. The findings suggest that discontinuation after achieving stability may lead to more favorable outcomes, highlighting the need for personalized treatment decisions in MS management. Further research is warranted to validate these findings and inform clinical practices.
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Affiliation(s)
- Nazire Pinar Acar Ozen
- Hacettepe University Faculty of Medicine, Department of Neurology, Sihhiye, Ankara 06100, Turkey; Hacettepe University MS Research and Application Center, Turkey.
| | - Ece Gok Dursun
- Hacettepe University Faculty of Medicine, Department of Neurology, Sihhiye, Ankara 06100, Turkey
| | - Asli Tuncer
- Hacettepe University Faculty of Medicine, Department of Neurology, Sihhiye, Ankara 06100, Turkey; Hacettepe University MS Research and Application Center, Turkey
| | - Rana Karabudak
- Hacettepe University Faculty of Medicine, Department of Neurology, Sihhiye, Ankara 06100, Turkey; Hacettepe University MS Research and Application Center, Turkey
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Kesidou E, Theotokis P, Damianidou O, Boziki M, Konstantinidou N, Taloumtzis C, Sintila SA, Grigoriadis P, Evangelopoulos ME, Bakirtzis C, Simeonidou C. CNS Ageing in Health and Neurodegenerative Disorders. J Clin Med 2023; 12:2255. [PMID: 36983254 PMCID: PMC10054919 DOI: 10.3390/jcm12062255] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 03/02/2023] [Accepted: 03/13/2023] [Indexed: 03/17/2023] Open
Abstract
The process of ageing is characteristic of multicellular organisms associated with late stages of the lifecycle and is manifested through a plethora of phenotypes. Its underlying mechanisms are correlated with age-dependent diseases, especially neurodegenerative diseases such as Alzheimer's disease (AD), Parkinson's disease (PD) and multiple sclerosis (MS) that are accompanied by social and financial difficulties for patients. Over time, people not only become more prone to neurodegeneration but they also lose the ability to trigger pivotal restorative mechanisms. In this review, we attempt to present the already known molecular and cellular hallmarks that characterize ageing in association with their impact on the central nervous system (CNS)'s structure and function intensifying possible preexisting pathogenetic conditions. A thorough and elucidative study of the underlying mechanisms of ageing will be able to contribute further to the development of new therapeutic interventions to effectively treat age-dependent manifestations of neurodegenerative diseases.
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Affiliation(s)
- Evangelia Kesidou
- Laboratory of Experimental Neurology and Neuroimmunology, 2nd Department of Neurology, AHEPA University Hospital, Aristotle University of Thessaloniki, 546 36 Thessaloniki, Greece (P.T.)
- Laboratory of Physiology, Faculty of Medicine, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece
| | - Paschalis Theotokis
- Laboratory of Experimental Neurology and Neuroimmunology, 2nd Department of Neurology, AHEPA University Hospital, Aristotle University of Thessaloniki, 546 36 Thessaloniki, Greece (P.T.)
| | - Olympia Damianidou
- Laboratory of Experimental Neurology and Neuroimmunology, 2nd Department of Neurology, AHEPA University Hospital, Aristotle University of Thessaloniki, 546 36 Thessaloniki, Greece (P.T.)
| | - Marina Boziki
- Laboratory of Experimental Neurology and Neuroimmunology, 2nd Department of Neurology, AHEPA University Hospital, Aristotle University of Thessaloniki, 546 36 Thessaloniki, Greece (P.T.)
| | - Natalia Konstantinidou
- Laboratory of Experimental Neurology and Neuroimmunology, 2nd Department of Neurology, AHEPA University Hospital, Aristotle University of Thessaloniki, 546 36 Thessaloniki, Greece (P.T.)
| | - Charilaos Taloumtzis
- Laboratory of Experimental Neurology and Neuroimmunology, 2nd Department of Neurology, AHEPA University Hospital, Aristotle University of Thessaloniki, 546 36 Thessaloniki, Greece (P.T.)
| | - Styliani-Aggeliki Sintila
- Laboratory of Experimental Neurology and Neuroimmunology, 2nd Department of Neurology, AHEPA University Hospital, Aristotle University of Thessaloniki, 546 36 Thessaloniki, Greece (P.T.)
| | - Panagiotis Grigoriadis
- Laboratory of Experimental Neurology and Neuroimmunology, 2nd Department of Neurology, AHEPA University Hospital, Aristotle University of Thessaloniki, 546 36 Thessaloniki, Greece (P.T.)
| | | | - Christos Bakirtzis
- Laboratory of Experimental Neurology and Neuroimmunology, 2nd Department of Neurology, AHEPA University Hospital, Aristotle University of Thessaloniki, 546 36 Thessaloniki, Greece (P.T.)
| | - Constantina Simeonidou
- Laboratory of Physiology, Faculty of Medicine, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece
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Cuthbert M, Lewandowska M, Freeman L, Devine C, Lee K, Kassam S. The Impact of Stopping Medications and Introducing a Whole Food Plant-Based Diet on Patients Living with Multiple Sclerosis - A Report of Two Cases. Am J Lifestyle Med 2023; 17:206-212. [PMID: 36896042 PMCID: PMC9989497 DOI: 10.1177/15598276221141403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
More than 2 million people live with multiple sclerosis worldwide and the prevalence has been increasing over time. Patients living with multiple sclerosis often explore diet and lifestyle interventions as a means of managing their symptoms and reducing reliance on medication; yet, these approaches are rarely discussed with their physicians. Currently, there is a lack of evidence on when to stop disease-modifying therapies (DMT), and recent research showed no statistically significant difference in the time between relapses when comparing participants who stopped DMT to those who did not, especially over the age of 45. This case report presents 2 patients with multiple sclerosis who made an informed decision to stop their DMT medications and have been managing their condition with a whole food plant-based diet and a healthy lifestyle approach. Over the period of 5 to 6 years since stopping the medications, each patient only had 1 multiple sclerosis flare-up to date. In the report, the focus is on the impact of diet on multiple sclerosis. It adds to currently available literature and encourages further research in the field of managing multiple sclerosis with lifestyle interventions.
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Affiliation(s)
- Monty Cuthbert
- Royal Sussex County Hospital, Brighton, UK (MC, ML); Plant Based Health Online, Bordon, UK(LF, SK); Conor Devine, Belfast, UK (CD); The Sensitive Foodie, Brighton, UK (KL); King's College London, London, UK (SK); and University of Winchester, Hampshire, UK (SK)
| | - Marta Lewandowska
- Royal Sussex County Hospital, Brighton, UK (MC, ML); Plant Based Health Online, Bordon, UK(LF, SK); Conor Devine, Belfast, UK (CD); The Sensitive Foodie, Brighton, UK (KL); King's College London, London, UK (SK); and University of Winchester, Hampshire, UK (SK)
| | - Laura Freeman
- Royal Sussex County Hospital, Brighton, UK (MC, ML); Plant Based Health Online, Bordon, UK(LF, SK); Conor Devine, Belfast, UK (CD); The Sensitive Foodie, Brighton, UK (KL); King's College London, London, UK (SK); and University of Winchester, Hampshire, UK (SK)
| | - Conor Devine
- Royal Sussex County Hospital, Brighton, UK (MC, ML); Plant Based Health Online, Bordon, UK(LF, SK); Conor Devine, Belfast, UK (CD); The Sensitive Foodie, Brighton, UK (KL); King's College London, London, UK (SK); and University of Winchester, Hampshire, UK (SK)
| | - Karen Lee
- Royal Sussex County Hospital, Brighton, UK (MC, ML); Plant Based Health Online, Bordon, UK(LF, SK); Conor Devine, Belfast, UK (CD); The Sensitive Foodie, Brighton, UK (KL); King's College London, London, UK (SK); and University of Winchester, Hampshire, UK (SK)
| | - Shireen Kassam
- Royal Sussex County Hospital, Brighton, UK (MC, ML); Plant Based Health Online, Bordon, UK(LF, SK); Conor Devine, Belfast, UK (CD); The Sensitive Foodie, Brighton, UK (KL); King's College London, London, UK (SK); and University of Winchester, Hampshire, UK (SK)
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