The standard approach to multiple sclerosis management has centered on indefinite use of disease-modifying therapy once treatment begins. However, this assumption has been increasingly challenged as clinicians confront an aging MS population and a growing body of data examining who might safely stop treatment.
Factors Influencing Discontinuation
Age, time since last relapse or MRI activity, and years since disease onset have emerged as central factors shaping the risk-benefit calculus of discontinuation. At the 2026 Consortium of Multiple Sclerosis Centers Annual Meeting, John Corboy, MD, presented data from DISCOMS and comparable controlled studies evaluating outcomes in patients who stop disease-modifying therapy after a prolonged period of stability.
Corboy noted that older individuals, perhaps over the age of 60 years, who haven’t had recent disease activity, are likely to have the best outcome should they choose to discontinue disease-modifying therapy. However, even in these patients, there’s still a low risk of new MRI activity, which raises concerns about the risk of medication versus the risk of the disease.
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Clinical Factors and Discontinuation
Corboy identified age as a major factor in determining whether a patient with MS may be an appropriate candidate for discontinuing disease-modifying therapy. The longer the time since last disease activity, the better the outcome. Additionally, the type of disease-modifying therapy being used may also make a difference, with some medications potentially being higher risk than others.
For example, the CD20 drugs like ocrelizumab, rituximab, and ofatumumab may be less likely to have issues with discontinuation, while cell-trafficking agents like fingolimod or natalizumab may be higher risk.
Corboy’s study, the DISCOMS study, found no difference in disability progression between patients who discontinued disease-modifying therapy and those who continued. However, there is still a need for therapies to address progression of disability, particularly in older patients.
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Unanswered Questions
Corboy noted that one of the major unanswered questions is the need for longer-term data on the outcomes of patients who discontinue disease-modifying therapy. Additionally, there is a need to understand the differences between medications and how they affect patients who discontinue treatment.
Corboy also raised the issue of whether it’s possible to mitigate the risks of disease-modifying therapy by spreading out infusions or injections, a concept known as de-escalation.
Research is ongoing.