Stopping MS Medication After 55: What the Newest Trial Shows

This week, four papers caught my attention. The first is a new randomized trial, “Disease-modifying therapies (DMTs) discontinuation in older relapsing-remitting multiple sclerosis (RRMS) patients with stable disease: Two-year randomized, controlled trial.”⁽¹⁾ The other three come from a 2026 consensus series by the Consortium of Multiple Sclerosis Centers on aging with MS. They cover the risks and benefits of DMTs as we age,⁽²⁾ comorbidity and polypharmacy,⁽³⁾ and multidisciplinary care and access to care.⁽⁴⁾

Many people with MS in their late 50s and 60s ask the same question: “My MS has been quiet for years. Do I still need my medication?” Stopping MS medication is a big decision, and until recently we had very little hard data to guide it.

In this blog, I’ll explain how MS and the benefit of DMTs change as we age, walk you through what the discontinuation trials found, cover the risks of staying on these drugs, and explain why your blood pressure, blood sugar, mood, and medication list matter as much as your MRI. Then I’ll tell you how I would approach this decision.

How Does MS Change as We Age?

First, let me explain what a disease-modifying therapy does. DMTs are medications that calm the immune attacks that cause relapses and new enhancing MRI lesions. Most of them work on the adaptive immune system, the T cells and B cells that are most active in younger people (under 45 years of age) with relapsing MS.⁽²⁾

As we age, MS tends to change character:

• Fewer relapses and new lesions. Inflammatory activity naturally declines with age.⁽²⁾
• More slow, quiet worsening. Progression that happens without relapses, called progression independent of relapse activity (PIRA), becomes much more common.⁽²⁾
• No zero-risk age. Researchers have not found an age at which the risk of a relapse, a new lesion, or worsening disability drops to zero.⁽²⁾

That shift matters because DMTs are best at stopping relapses and new lesions, not slowing progression. A 2017 meta-analysis of DMT trials found that benefit shrinks with age and that there was no clear benefit on disability above about age 53.⁽⁵⁾ The consensus authors caution that very few trial participants were over 55, so we are extrapolating.⁽²⁾

What Happens When Older Adults Stop Their DMT?

The New Trial

Researchers at Hamadan University of Medical Sciences in Iran enrolled 178 people with relapsing-remitting MS.⁽¹⁾ Everyone was 55 or older, had mild disability (EDSS of 3 or less), and had no relapses or new MRI activity for at least five years. Half were randomly assigned to keep taking their DMT and half to stop. They were followed for two years.

Results:

None of these differences was statistically significant. Disability scores rose slightly in both groups during the first year.⁽¹⁾

Takeaway: In carefully selected older adults with long-quiet MS, stopping did not cause a clear jump in relapses, new lesions, or disability over two years.

There are important caveats. The trial was small, so a modest increase in risk could have been missed. The abstract does not say which DMTs people were taking. And the five-year quiet period required here is longer than the two to three quiet years many people have in mind. Diet and other modifiable lifestyle factors were also not tracked.

What the Earlier Trials Showed

Two earlier randomized trials looked at the same question:

• DISCOMS (United States): In 259 people aged 55 and older, those who stopped had a few more silent MRI lesions but similar disability worsening (12.3% vs 11.1%) over about two years.(6) Diet and lifestyle were not tracked.
• DOT-MS (Netherlands): This trial stopped early when 17.8% of those who stopped had new activity, compared with none who continued, mostly in younger people (median age 46).(7) Again, diet and lifestyle were not tracked.

Age clearly matters. So does the drug. In a French study of people 50 and older, relapses came back faster after stopping natalizumab (Tysabri) or fingolimod (Gilenya), and disability progressed faster after stopping natalizumab.⁽⁸⁾ Never stop these drugs on your own.

What Are the Risks of Staying on a DMT as You Age?

The other side of the scale is risk. Infections, cancers, and weaker responses to vaccines all become more common with age, and they may be more common in people with MS.⁽²⁾ The consensus authors flag specific concerns by drug type:⁽²⁾

• B-cell depleting drugs such as ocrelizumab (Ocrevus), ofatumumab (Kesimpta), rituximab, and ublituximab (Briumvi): infections and weaker vaccine responses.
• Cell-depleting drugs in general: a possible increase in cancer risk.
• S1P modulators such as fingolimod: worsening of vascular risk and a possible cancer risk.

Other health conditions such as diabetes, high blood pressure, heart disease, and cancer can raise these risks further and often lead people to stop their DMT early.⁽²⁾

So the question shifts with age. In your 30s, a DMT offers a large benefit with modest risk. In your 60s, the benefit is often smaller and the risk is often larger.

Why Your Other Health Conditions Matter So Much

This is the part of the research I want every reader to hear. As people with MS age, other chronic conditions pile up, and they drive MS outcomes.

• High blood pressure rose from 13.4% of people with MS aged 30 to 34 to 65.4% of those aged 70 to 74 in a large US health records study.⁽³⁾
• Cardiometabolic conditions such as diabetes, high cholesterol, and high blood pressure were linked to a 21% higher risk of MS disease activity across 17 clinical trials.⁽⁹⁾
• Depression was linked to a 21% higher relapse rate and a 29% higher rate of disability worsening in the same analysis.⁽⁹⁾ Mood and anxiety disorders are also linked to faster disability progression.⁽¹⁰⁾

Vascular conditions are linked to more relapses, faster disability, more brain shrinkage, and higher mortality.⁽³⁾ That means managing your blood pressure, blood sugar, cholesterol, and mood is MS care.

The Medication Pile-Up

Polypharmacy means taking five or more medications at once. In a Canadian study, it affected 29% of people with MS aged 50 to 64 and nearly 44% of those 65 and older.⁽³⁾ The consensus authors recommend a full medication review and avoiding sleeping pills such as zolpidem and benzodiazepines, which raise the risk of falls and memory problems.⁽³⁾

My Take

As a researcher, I find these results reassuring but not final. Notably, none of these studies examined diet or other modifiable lifestyle factors that have been shown to significantly reduce fatigue and improve quality of life. We now have three randomized trials, and together they suggest that for carefully selected people over 55 with long-quiet MS, stopping a DMT is a reasonable option to discuss. That is particularly true if you have also improved your diet quality, have a stress management practice, and have a regular exercise program that meets the goal of 150 minutes of moderate-intensity (or 75 minutes of high-intensity) exercise each week plus two sessions of strength training each week. The risk of new activity is real but modest, and it is highest in people who are younger, recently active, or coming off natalizumab or fingolimod.^(1,6-8)

As a clinician, I want my patients to see this as a shared decision, not a default. Some people will feel safer staying on their DMT, and that is a valid choice. Others are dealing with infections, side effects, or a long list of pills and have fully optimized their modifiable lifestyle factors. For those people, stepping down makes sense.

I have lived on both sides of this, as a physician and as a person with progressive MS. I was experiencing relentless worsening for seven years despite treating my disease very aggressively. I adopted a Paleolithic diet and took targeted supplements to support my mitochondria for four years. That helped somewhat with the fatigue, but I was still progressing. Then I discovered functional medicine and took a course on neuroprotection, which gave me a longer list of supplements. I checked my food sensitivities and discovered I was sensitive to eggs. I redesigned my paleo diet to get more of those nutrients from food. I added neuromuscular electrical stimulation of my muscles to my physical therapy, and I went back to a daily meditation practice. That is when my progressive decline stopped and was replaced by a rapid improvement in function. My neurologist told me to taper my DMT over the next month and then stop it. That was 12 years ago. I continue to do amazingly well. I can bike for hours, I strength train three times a week, and I do high-intensity interval training.

What strikes me most is how much of the risk in these papers is something you can change. High blood pressure, high blood sugar, inactivity, smoking, and depression all speed up MS. You can improve your diet, adopt a stress-reducing practice, and begin an exercise program. In my lab at the University of Iowa, our multimodal program of diet, exercise, electrical stimulation of muscles, and stress reduction improved fatigue in people with progressive MS.⁽¹¹⁾ Whether or not you stay on your DMT, there are many levers that protect your brain as you age.

Next Steps for You

Talk With Your Neurologist

Never stop a DMT on your own. If you are over 55 and your MS has been quiet for years, bring these questions to your next visit:

• How many years has it been since my last relapse or new MRI lesion?
• Is my DMT one with a rebound risk if I stop, such as natalizumab or fingolimod?
• What monitoring plan would we follow if I stop?

One example from the consensus paper: clinic visits every six months and a yearly MRI for two years after stopping.⁽²⁾

Food First

• Eliminate added sugar and white flour. They are stripped of nutrients, feed the wrong microbes, and drive the high blood sugar and blood pressure that speed up MS.
• Work toward nine cups of vegetables and fruit a day: three cups of leafy greens, three cups of sulfur-rich vegetables (cabbage family, onion family, mushrooms), and three cups of deeply colored vegetables and berries.
• Eat adequate protein and omega-3 rich fish, such as wild salmon and sardines.
• If insulin resistance is a concern, start with a paleo-style diet before considering ketogenic eating.

Targeted Supplements

• A foundation of a multivitamin/multimineral, vitamin D3/K2, magnesium, and fish oil. I have included all of these in the Wahls Protocol® Basic Support kit.
• For heart and vascular support, the Wahls Protocol® Heart Support kit combines Advanced Multi, Complete Carnitine, D3K2 5000iu, MindFuel Omega, and Ultra CoQ10.
• To help maintain healthy blood sugar levels, consider Blood Sugar Synergy.
• Bring every supplement to your medication review so your clinician and pharmacist can check for interactions.

Protect Your Mood, Body, and Mind

• Exercise daily. Ask your neurologist for a physical therapy consult to design a program that fits your abilities.
• Ask your clinician to screen you for depression. It is common and treatable. If you are in crisis, call or text 988 for confidential support.
• Ask for a full review of your medications, especially sleeping pills and anticholinergic drugs.
• Keep your blood pressure, blood sugar, and cholesterol checked regularly.

Do this alongside your medical team, not instead of them. Whether you continue your DMT or not, the choices you make every day can help you age well with MS.

Want to Go Deeper?

To learn what you can do to support myelin repair as you age, explore my Ultimate Myelin Repair Toolkit for People with MS.

References

1. Daneshyar S, Ghiasian M, Khazaei S, Alborzi K, Ebadi M. Disease-modifying therapies (DMTs) discontinuation in older relapsing-remitting multiple sclerosis (RRMS) patients with stable disease: two-year randomized, controlled trial. Caspian J Intern Med. 2026;17(3):589-594.
2. Corboy JR, Morrow SA, Wilken J, et al. Risks and benefits of disease-modifying therapies in people aging with multiple sclerosis. Int J MS Care. 2026. doi:10.7224/1537-2073.2025-090
3. Marrie RA, Bainbridge J, Bobryk P, et al. Comorbidity, polypharmacy, and aging in multiple sclerosis. Int J MS Care. 2026. doi:10.7224/1537-2073.2025-088
4. Stewart R, Stacom R, Bainbridge J, et al. Aging and multiple sclerosis: multidisciplinary care and access to care. Int J MS Care. 2026. doi:10.7224/1537-2073.2025-091
5. Weideman AM, Tapia-Maltos MA, Johnson K, Greenwood M, Bielekova B. Meta-analysis of the age-dependent efficacy of multiple sclerosis treatments. Front Neurol. 2017;8:577.
6. Corboy JR, Fox RJ, Kister I, et al. Risk of new disease activity in patients with multiple sclerosis who continue or discontinue disease-modifying therapies (DISCOMS): a multicentre, randomised, single-blind, phase 4, non-inferiority trial. Lancet Neurol. 2023;22(7):568-577.
7. Coerver EME, Fung WH, de Beukelaar J, et al. Discontinuation of first-line disease-modifying therapy in patients with stable multiple sclerosis: the DOT-MS randomized clinical trial. JAMA Neurol. 2025;82(2):123-131.
8. Jouvenot G, Courbon G, Lefort M, et al. High-efficacy therapy discontinuation vs continuation in patients 50 years and older with nonactive MS. JAMA Neurol. 2024;81(5):490-498.
9. Salter A, Lancia S, Kowalec K, Fitzgerald KC, Marrie RA. Comorbidity and disease activity in multiple sclerosis. JAMA Neurol. 2024;81(11):1170-1177.
10. McKay KA, Tremlett H, Fisk JD, et al. Psychiatric comorbidity is associated with disability progression in multiple sclerosis. Neurology. 2018;90(15):e1316-e1323.
11. Bisht B, Darling WG, Grossmann RE, et al. A multimodal intervention for patients with secondary progressive multiple sclerosis: feasibility and effect on fatigue. J Altern Complement Med. 2014;20(5):347-355.