Can I Take A Break From Disease Modifying Therapies?

Question:
After years of clear MRI's and good neurological exams, why should I keep taking the DMT? I have been through Copaxone, Avonex, Tysabri and now Tecfidera. Would it be unwise to take maybe a month, six months or a year off from everything and come back to treatment if things change?

Answer:
This is a good question, but not one that I cannot reasonably answer over a blog.  (Mainly because I do not know your full story and I haven't had the opportunity to review your scans or examine you in person.)

What I can do is speak on DMT-governing principles which you can take back to your physician for discussion.

Some guiding principles in the use and prescribing of DMTs:

1. DMTs are partially effective but serve an important purpose.  To read more, see my blog here:  http://www.healthcarejourney.com/physician-blog/a-commonly-asked-question-about-disease-modifying-therapies-for-multiple-sclerosis
2. We define disease free status as:  no clinical attacks (or relapses), no increase in disability status (as measured on the neurologic exam), and no change on the MRI scans (no new/enlarging/contrast enhancing lesions).
3. If you have been "disease free" for 10 years, then odds are that the DMTs are not doing that (since they are partially, and not completely, effective).  This may prompt discussion with your physician to monitor off DMTs with periodic MRI and clinical follow-up.
4. The "disease free" status is a high bar and difficult to achieve (in fact, this has to be confirmed by a neurologist).  If it is met, then I have a conversation with my patients about monitoring off DMTs.

In your specific case, I have no way of knowing if you've met the criteria of "disease free" status.  Cycling through different DMTs usually means that your physician has found something that suggests that your prior DMTs haven't been effective enough.  I would suggest you speak with your physician about this.

I hope this helps.

A. Scott Nielsen MD MMSc
Virginia Mason Multiple Sclerosis Center

#MS #diseasemodifyingtherapies #multiplesclerosis #DMTs