Is it safe for me to stop taking Tysabri?

Here is My Question:
I am 70 and Negative for JCV Virus. My doctor wants to take me off Tysabri (I have been on for approximately 13 years. He wants to take me off cold turkey. Is that Safe? Will I experience significant breakthrough symptoms? Should I be weaned off rather than cold turkey? Any suggestions would be so helpful. 

Answer:
This is a difficult question to answer without more detailed information. To begin with, it is unusual for people who are 70 to still be taking disease modifying therapies. Let me give you some information to help you discuss this question with your MS doctor. Rebound relapses after stopping Tysarbi,

1. Tend to occur in younger relapsing patients, usually under the age of 60, if not even younger. It is far less common in older patients
2. Tend to occur in patients with evidence of inflammatory activity prior to starting Tysabri. This means a verified relapse or enhancing MRI activity prior to starting Tysabri. 

None of the currently approved disease modifying therapies have been tested in controlled trials that included people over the age of 60. Older patients more commonly experience relatively stable or secondary progressive MS without relapses (SPMS without relapses), stages of MS either not responsive to DMTs or without evidence that DMTs are required. Perhaps this is why your neurologist is stopping the Tysabri. If you are worried about a rebound relapse, you can always ask him for a single infusion of anti-CD20 therapy (Rituximab 100 mg, Ocrevus 300 mg or Briumvi 150 mg) within 2-3 months of stopping the Tysabri to prevent a relapse after excluding the remote possibility of pre-symptomatic PML with a repeat MRI of the brain.

Good luck

Revere P (Rip) Kinkel, MDProfessor Emeritus
Neuroscience Department
University of California San Diego