Stopping disease-modifying treatments in multiple sclerosis: a meta-analysis with meta-regression

We aim at conducting a quantitative synthesis (meta-analysis) of the currently available real world evidence on discontinuation of disease-modifying treatments (DMTs) in patients with multiple sclerosis (MS), focusing on platform self-injectable and oral DMTs, i.e. interferon beta, glatiramer acetate, dimethyl fumarate, teriflunomide. We will explore: (1) the event rates for relapses and disability accrual after stopping platform DMTs; (2) the main determinants (moderators) for increased rates of relapse and disability accrual after stopping platform DMTs. We do not include studies about discontinuation of high-efficacy DMTs, i.e. monoclonal antibodies and sphingosine-1-phospate (S1P) receptors modulators whose discontinuation is commonly driven by safety issues and is freqeuntly associated with huge reactivation of disease activity (rebound).