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The aim of this study is to identify whether it is possible to safely discontinue treatment in relapsing-onset MS patients who have shown no evidence of active inflammation in the years prior to inclusion clinically and/or radiologically. The secondary objectives address the questions whether the discontinuation of first-line treatment has an effect on disability progression and whether the discontinuation of first-line treatment improves the quality of life for the patient. Furthermore, blood collections will be included to assess whether it is possible to retrospectively predict possible return of inflammatory activity with biomarkers such as neurofilament light (NFL) or patient characteristics such as disease activity prior to disease modifying therapy (DMT). In case of emerging disease activity after the cessation of therapy we will assess if reinitiation will lead to NEDA again, and if there are long-term consequences. If possible, post-hoc analysis are performed for the different types of treatment compounds.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Discontinuation of DMT | Experimental | Discontinuation of first-line disease modifying therapy (any of the interferons, glatiramer acetate, dimethylfumarate, teriflunomide) |
|
| Continuation of DMT | No Intervention | Continuation of first-line disease modifying therapy (any of the interferons, glatiramer acetate, dimethylfumarate, teriflunomide) |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| DMT | Drug | Discontinuation of patients' own disease modifying therapy (any of the interferons, glatiramer acetate, dimethylfumarate, teriflunomide) |
|
| Measure | Description | Time Frame |
|---|---|---|
| Clinical relapses | New clinically confirmed relapses (defined according to the definition most often used in MS phase-III trials: the onset of new or recurrent symptoms that last > 24 hours, that are accompanied by new objective abnormalities on a neurological examination and that are not explained by non-MS processes such as fever, infection, severe stress or drug toxicity). | 2 years |
| New lesions on MRI-brain | New inflammatory disease activity on MRI (defined as 3 or more lesions on T2-weighted vimages or 2 or more gadolinium enhancing lesions on T1-weighted post-contrast MRI). | 2 years |
| Measure | Description | Time Frame |
|---|---|---|
| EDSS (Expanded Disability Status Scale) | This score indicates disability on a scale of 0 to 10. A higher score indicates more disability. | 2 years |
| 9-hole peg test | 9-hole peg test (9HPT): test on hand function, measured in seconds. A shorter time indicates a better hand function. |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Eline Coerver, MSc | Contact | +31204440717 | e.coerver@amsterdamumc.nl | |
| Eva Strijbis, dr. | Contact | e.strijbis@amsterdamumc.nl |
| Name | Affiliation | Role |
|---|---|---|
| J. Killestein, prof. dr. | Amsterdam UMC, location VUmc | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Amsterdam UMC | Recruiting | Amsterdam | Netherlands |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 39652340 | Derived | Coerver EME, Fung WH, de Beukelaar J, Bouvy WH, Canta LR, Gerlach OHH, Hoitsma E, Hoogervorst ELJ, de Jong BA, Kalkers NF, van Kempen ZLE, Lovenich H, van Munster CEP, van Oosten BW, Smolders J, Vennegoor A, Zeinstra EMPE, Barrantes-Cepas M, Kooij G, Schoonheim MM, Lissenberg-Witte BI, Teunissen CE, Moraal B, Barkhof F, Uitdehaag BMJ, Mostert J, Killestein J, Strijbis EMM. Discontinuation of First-Line Disease-Modifying Therapy in Patients With Stable Multiple Sclerosis: The DOT-MS Randomized Clinical Trial. JAMA Neurol. 2025 Feb 1;82(2):123-131. doi: 10.1001/jamaneurol.2024.4164. |
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| ID | Term |
|---|---|
| D009103 | Multiple Sclerosis |
| D020529 | Multiple Sclerosis, Relapsing-Remitting |
| D020528 | Multiple Sclerosis, Chronic Progressive |
| ID | Term |
|---|---|
| D020278 | Demyelinating Autoimmune Diseases, CNS |
| D020274 | Autoimmune Diseases of the Nervous System |
| D009422 | Nervous System Diseases |
| D003711 | Demyelinating Diseases |
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| ID | Term |
|---|---|
| D007372 | Interferons |
| D000068717 | Glatiramer Acetate |
| D000069462 | Dimethyl Fumarate |
| C527525 | teriflunomide |
| ID | Term |
|---|---|
| D016207 | Cytokines |
| D036341 | Intercellular Signaling Peptides and Proteins |
| D010455 | Peptides |
| D000602 | Amino Acids, Peptides, and Proteins |
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|
| 2 years |
| Timed 25-Foot Walk | Timed 25-foot walk (T25FW): walking test, measured in seconds. A shorter time indicates a better walking function. | 2 years |
| Symbol Digits Modalities Test | Symbol Digits Modalities Test (SDMT): measures cognition. Scored with a number from 0 to 110, a higher score indicates better cognitive function. | 2 years |
| MRI-parameter: T1 post-contrast lesion number | Number of lesions on T1 post-contrast MRI | 2 years |
| MRI-parameter: T2 post-contrast lesion number | Number of lesions on T2-MRI | 2 years |
| Multiple Sclerosis Impact Scale (MSIS-29) | Questionnaire on the impact of MS on day-to-day life | 2 years |
| Short Form health survey (SF-36) | Questionnaire on general health | 2 years |
| Checklist Individual Strength (CIS20r) | Questionnaire on fatigue | 2 years |
| Treatment Satisfaction Questionnaire for Medication (TSQM) | Questionnaire on treatment satisfaction | 2 years |
| EuroQol 5 dimensions questionnaire (EQ-5D-5L) | Questionnaire on quality of life and costs | 2 years |
| Medical consumption questionnaire (iMCQ) | Questionnaire on medical consumption | 2 years |
| Productivity costs questionnaire (iPCQ) | Questionnaire on productivity | 2 years |
| Neurofilament light level in serum | Neurofilament light levels in serum | 2 years |
| D001327 | Autoimmune Diseases |
| D007154 | Immune System Diseases |
| D002908 | Chronic Disease |
| D020969 | Disease Attributes |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D011506 | Proteins |
| D001685 | Biological Factors |
| D005650 | Fumarates |
| D003998 | Dicarboxylic Acids |
| D000144 | Acids, Acyclic |
| D002264 | Carboxylic Acids |
| D009930 | Organic Chemicals |