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MS – DMT Discontinuation Considerations — SCE Neurology MCQ

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HardMultiple Sclerosis & CNS InflammationMS – DMT Discontinuation ConsiderationsSCE Neurology

A stable patient with relapsing-remitting multiple sclerosis has had no clinical or MRI activity for five years on high-efficacy therapy and asks to stop. What is the best response?

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Correct answer: E — Review age, prior activity, treatment risks and rebound potential in a specialist shared decision, with a monitoring plan if de-escalation is chosen, clinically

The best answer is “Review age, prior activity, treatment risks and rebound potential in a specialist shared decision, with a monitoring plan if de-escalation is chosen, clinically”. Evidence for stopping is treatment- and patient-specific; some agents carry rebound risk, so planned specialist de-escalation and surveillance are essential. “Stop immediately because five quiet years prove cure” can be reasonable in another presentation, but it does not account for the defining feature here. “Continue every disease-modifying therapy for life without review” can be reasonable in another presentation, but it does not account for the defining feature here. “Replace treatment with corticosteroids indefinitely” can be reasonable in another presentation, but it does not account for the defining feature here. “Stop imaging once treatment is discontinued” can be reasonable in another presentation, but it does not account for the defining feature here.

Reference: NICE NG220 multiple sclerosis recommendations: https://www.nice.org.uk/guidance/ng220/chapter/Recommendations