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Is It Time to Reassess Disease Modifying Therapies for Older Adults with MS?
Recent research shows that older adults with Multiple Sclerosis (MS) who have reached a period of prolonged stability may be able to safely stop their disease-modifying therapy (DMT) with minimal risk. This intriguing finding has significant implications for concierge medical practices catering to aging patients seeking personalized care.
Understanding the Landscape of MS in Older Patients
As people age, MS can change its course, leading to unique opportunities to reevaluate treatment options. John R. Corboy, MD, a prominent neurologist, has highlighted that there are "substantial changes — pathological, immunological, clinical, radiological" — occurring over time in patients living with MS. These shifts may influence how well older patients respond to DMTs, which are often designed based on data from younger populations.
Minimal Risk in Therapy Discontinuation
Corboy presented his findings during the ACTRIMS conference, indicating that older adults who have maintained stability for around five years could consider discontinuing DMT. The DISCOMS and DOT-MS studies, which focused on this demographic, suggest that while there was a slight increase in the incidence of new MRI lesions for those who stopped their therapy, the clinical significance of these changes remains unclear.
Approximately 40% of patients over 60 are still using DMT, primarily because clinical trials overwhelmingly favor younger participants, often excluding those over the age of 55. As a result, there is insufficient data available to understand the benefits of DMT for older patients, making this new research crucial.
Considerations for Concierge Medicine Practices
This new understanding about DMT discontinuation provides an essential opportunity for concierge medical practices. By recognizing that some older patients might benefit from stopping their therapy, these practices can enhance patient engagement. Patients value providers who personalize their treatment, taking into account their unique health statuses and life stages.
The Importance of Monitoring Post-DMT
While the risks of discontinuing therapy may be minimal, ongoing monitoring remains vital. Corboy emphasizes that transitioning off DMT doesn’t mean abandoning care but rather redefining it. Specialists advise regular check-ups to ensure that the absence of treatment does not lead to unnoticed disease activity. This management approach could also solidify practices' reputations as leaders in comprehensive patient care.
Engaging Patients with New Information
For concierge practices, sharing these insights can encourage patients to discuss their treatment options openly. By cultivating a space for communication and education, these practices can foster stronger connections with their patients, potentially leading to increased satisfaction and loyalty.
In summary, as more data emerges, concierge medical practices have a unique opportunity to cater to the specific needs of older MS patients. Education about the possibility of safely discontinuing DMT, while emphasizing the importance of monitoring, could enhance patient relationships and care outcomes.
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