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Interview with Aaron Miller: Current controversy in management: interactive case discussion

MILLER-HD

Clinicians are mainly concerned with getting patients on treatment, but what do we think about getting patients to stop treatment? In our interview with Prof. Miller he described the case of a woman patient who was on injectable glatiramer acetate for her multiple sclerosis. 5-6 years after starting the treatment she started to complain about significant lipoatrophy in her arms, which were becoming unsightly. The patient then gradually reduced the dose to 2 per week and then asked to stop glatiramer acetate. Given that she had been free of MS both clinically and lesions for so many years, the patient was monitored off treatment.

Is there data available on stopping treatment? According to Prof. Miller there is very limited information on this: Gary Birnbaum from Minnesota presented data on 62 patients whom he had recommended to stop therapy. These were older patients who had been disease free for a number of years on disease modifying therapy. With several year follow-up, only 4/62 patients had new disease activity. He also had 10 patients who had themselves decided to come off treatment, but they were less successful. Younger patients and those with lower disability (EDSS score) may have a poorer chance if they stop therapy.  This has also been supported by the MSBase Registry of 30,000 patients.

Prof. Miller also mentions John Corboy, University of Colorado, who has put forward a grant request to the Patient-Centered Outcomes Research Institute (PCORI) for a randomized prospective controlled trial of stopping disease-modifying therapy. This trial has just been awarded funding. Patients will be over 55, who have been on disease modifying therapy for at least 5 years, and who have been completely disease free during this time (MRI, disease progression and relapse).

This interview has been recorded at ECTRIMS 2015, October 2015, Barcelona, Spain.