Evidence map›Paper›PMID 31916231›Full record

ArticleDrugs & aging2020

Informing Medication Discontinuation Decisions among Older Adults with Relapsing-Onset Multiple Sclerosis.

Natalie A Schwehr, Karen M Kuntz, Eva A Enns, Nathan D Shippee, Elaine Kingwell, Helen Tremlett, Adam F Carpenter, Mary Butler, BeAMS Study group

Open access · greenAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Drugs & aging, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed
1.6field-weighted citation impact, top 17% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed, 14 citations in OpenAlex.

  1. Trial
  2. Review
  3. Review
  4. CNS Ageing in Health and Neurodegenerative Disorders.Journal of clinical medicine · 2023
    Review
  5. Article
  6. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors at 2 institutions in 2 countries.

Natalie A SchwehrDivision of Health Policy and Management, University of Minnesota School of Public Health, MMC729, 420 Delaware St. SE, Minneapolis, MN, 55455, USA. schwe425@umn.edu.ORCID http://orcid.org/0000-0003-1451-5294
Karen M KuntzDivision of Health Policy and Management, University of Minnesota School of Public Health, MMC729, 420 Delaware St. SE, Minneapolis, MN, 55455, USA.
Eva A EnnsDivision of Health Policy and Management, University of Minnesota School of Public Health, MMC729, 420 Delaware St. SE, Minneapolis, MN, 55455, USA.
Nathan D ShippeeDivision of Health Policy and Management, University of Minnesota School of Public Health, MMC729, 420 Delaware St. SE, Minneapolis, MN, 55455, USA.
Elaine KingwellMedicine (Neurology), University of British Columbia and The Djavad Mowafaghian Centre for Brain Health, 2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada.
Helen TremlettMedicine (Neurology), University of British Columbia and The Djavad Mowafaghian Centre for Brain Health, 2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada.ORCID http://orcid.org/0000-0001-5804-2535
Adam F CarpenterDepartment of Neurology, University of Minnesota Medical School, 420 Delaware St SE, Minneapolis, MN, 55455, USA.
Mary ButlerDivision of Health Policy and Management, University of Minnesota School of Public Health, MMC729, 420 Delaware St. SE, Minneapolis, MN, 55455, USA.
BeAMS Study group
University of Minnesota · USUniversity of British Columbia · CA

Funding

University of Minnesota Clinical and Translational Science Institute (UMN CTSI)UL1TR002494 · NCATS · UNIVERSITY OF MINNESOTA · PI BLAZAR, BRUCE R, WEISDORF, DANIEL J · 2018 to 2022
$34.9M
NCATS NIH HHS UL1 TR002494
6 · The paper itself

Abstract

backgroundFor older adults with relapsing-onset multiple sclerosis (MS), limited information is available to inform if, or when, disease-modifying drugs (DMDs) may be safely discontinued.

objectiveThe aim of this study was to project the outcomes of DMD discontinuation among older adults with relapsing-onset MS.

methodsWe projected the 10-year outcomes of discontinuation of a DMD (interferon-β, fingolimod, or natalizumab) among older adults (aged 55 or 70 years) who were relapse-free for 5 or more years and had not reached an Expanded Disability Status Scale (EDSS) score of 6. Outcomes included the percentage of people who had at least one relapse or reached EDSS 6, and quality-adjusted life-years (QALYs), which incorporated both relapses and disability. We used a simulation modeling approach. With increased age, relapses decreased and the effectiveness of DMDs for disability outcomes also decreased.

resultsWe found lower projected benefits for DMD continuation at 70 years of age than at 55 years of age. Compared with discontinuation, the projected benefit of DMD continuation ranged from 0.007 to 0.017 QALYs at 55 years of age and dropped to 0.002-0.006 at 70 years of age. The annual projected benefits of DMD continuation (0.1-3.0 quality-adjusted life-days) were very low compared with typical patient preferences regarding treatment burden.

conclusionThe benefits of DMDs may not be substantial among older adults with relapsing-onset MS. Direct clinical evidence remains limited and the decision of whether to discontinue a DMD should also take into account patient preferences. It is important to gain a better understanding of how age-related changes in the trajectory of relapsing-onset MS affect treatment effectiveness among older adults.

Indexed as

Clinical Decision-MakingWithholding TreatmentAgedFemaleHumansMaleMiddle AgedModels, StatisticalMultiple Sclerosis, Relapsing-RemittingTreatment Outcome

Identifiers

PMID31916231
PMCPMC7047543
OpenAlexW3000103394

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.