Dr John Corboy on Probing Patient Quality of Life Off Medication for MS

An interesting outcome is whether or not patients’ quality of life with multiple sclerosis (MS) is actually better off of medication because they do not have adverse effects related to their medications, explained John Corboy, MD, professor of neurology, University of Colorado Denver, School of Medicine, and co-director of the Rocky Mountain MS Center at Anschutz Medical Campus.

Transcript

What must be known about discontinuing therapies for MS?

So the primary safety issue is whether or not there’s a return of disease activity with MS. But for both patients who stay on or who go off medications, we’re interested in whether or not they’re just safety outcomes that are different. In theory, if you are off a medication, you should not have any side effects from that medication: either blood abnormalities, liver abnormalities, whatever it may be, or other risks or side effects associated with that. Unless, of course, there’s some carryover from prior use, then that risk doesn’t go away.

But one of the outcomes that we’re very interested in is whether or not people’s quality of life is actually better off of medication because they’re not having side effects or other things related to their medications. Perhaps they have more money in their pocket because they’re paying out less for medications. They have less doctor’s office visits or other things like that. Potentially savings, as well. So we’re definitely interested in the potential downsides. But in this sense with the thought that if you’re off medication, you should arguably do better from a scientific point of view and a cost point of view for all the obvious reasons.

In addition, I would say, as people age, you have more other conditions, comorbidities, diabetes, high blood pressure, cancer, and perhaps most importantly, infections that are a risk as you age, especially if you have significant disability. Older individuals with disability, especially [those in a] wheelchair, are at high risk of having infections. If you go on another medication, that makes that risk greater; that’s not trivial. And so one thing that would be important to know is whether or not there is essentially less problems that are accrued in people who are not taking medications that may alter their immune system.

Now, one thing notable about our study [DISCO-MS] is that most of the individuals in the study, over 70%, are still using older injectable medications. And these people are very happy with their therapy. Over 75% are satisfied or very satisfied with the disease-modifying therapy that they’re using. And so they’ve not been having a lot of side effects or other things with their medications, so we may not see a significant increase in patient satisfaction or happiness with the use of their medication. And we may not see a lot of increase of infections or other problems that might be seen with more highly effective but more immunosuppressive medications, because many of our patients are actually still using older, less immunosuppressive approaches.

So we will not answer all questions related to this population. But I think part of the view that we have with this study is to answer a very basic question in a relatively restricted population. If we cannot show that it appears to be safe to consider a trial off disease-modifying therapy in this kind of population, it’ll be extremely difficult to show it in patients who’ve had somewhat more recent disease activity and younger patients, and those who are using more highly immunosuppressive therapies, or other things—in a different population.

If we can’t show it in this population, I would be relatively skeptical that we can show in other patient populations that it is safe to consider a trial off medication.