Guidelines on Discontinuing MS Treatment: Ill-Conceived?

Andrew Wilner, MD; Daniel Kantor, MD


July 29, 2015

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Andrew N. Wilner, MD: This is Dr Andrew Wilner, reporting for Medscape. I am here with Dr Daniel Kantor, immediate past president of the Florida Society of Neurology and the founder of Medical Partnership 4 MS (MP4MS). Dan, you were telling me at a conference a couple of months ago about a new report on discontinuing multiple sclerosis (MS) medications. It has been my understanding that once you are on an MS medication, you pretty much stay on it, just like for hypertension or diabetes. What’s up with this new report?

Daniel Kantor, MD: A federal agency called the Agency for Healthcare Research and Quality (AHRQ) has put out a draft document for comment.[1] Instead of being about when to start therapy or which therapy to select, it is about discontinuing therapy. We have a big fear that third-party payers and others will use this document as an excuse to get patients off of the same medications that have changed the face of MS. In 1992, before there were any FDA-approved disease-modifying therapies for MS, our waiting rooms were full of wheelchairs. Now, we have 12 different branded medications, and while some people are still in wheelchairs, many more people are living healthy, active lifestyles with MS. We think that disease-modifying therapies have had a lot to do with this. The MS community wants to see more about treatment selection and not about taking patients off of medications.

Dr Wilner: How have you responded to this report?

Dr Kantor: The response has been fast and comprehensive, and it has really shown that the MS community can come together. The MP4MS responded with a 15-page document outlining the errors and problems with the draft AHRQ document.[2] We also had it signed by eight other organizations, as well as over 100 physicians, nurses, physician assistants, and nurse practitioners. We have seen a response from nonprofit organizations. The MS Coalition brings together eight nonprofit organizations dedicated to MS that have also responded to the AHRQ.

Dr Wilner: As far as I know, there is no indication to stop therapy in patients with relapsing-remitting MS from a medical point of view. Is this correct?

Dr Kantor: You are absolutely correct. There is no indication to stop MS disease-modifying therapies. It's neither in the FDA-approved prescribing information or the evidence-based literature, and it's certainly not from clinical experience.

Dr Wilner: What is going to happen with this report?

Dr Kantor: The report was written by an evidence-based practice center at the University of Minnesota. They received federal grants to produce this document. The AHRQ then sends this out for comment. The draft comments are then looked at and there should be responses to each of the letters that have been sent in. Finally, they will come out with a final document or report. What we are hoping is that they will realize that they need to go back to the drawing board. They need to listen to the constituents, the stakeholders, and the patients and their families. Instead of having a document that is about stopping therapy, they need to think about developing a document that is about treatment or about selecting which treatment is best for a particular patient, so that we can have the best individualized care.

Dr Wilner: Dan, I want to thank you very much for sharing this new information with the Medscape viewers.


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