What is the role of the DISCO trial in the treatment of Multiple Sclerosis (MS)?

From the Guidelines

The DISCO trial is not mentioned in the provided evidence, however, based on the available information, the most recent and highest quality study on the treatment of Multiple Sclerosis (MS) is the MIST trial, which demonstrated the efficacy and safety of autologous haematopoietic stem cell transplantation (AHSCT) in treating relapsing-remitting MS 1.

Key Findings

• The MIST trial showed that AHSCT was superior to disease-modifying therapies (DMTs) in terms of progression-free survival, relapse-free survival, and no evidence of disease activity (NEDA-3) at 5 years 1.
• The trial used a cyclophosphamide-ATG conditioning protocol and demonstrated a significant reduction in disease activity and improvement in functional outcomes compared to DMTs 1.
• The European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) and the European Society for Blood and Marrow Transplantation (EBMT) Autoimmune Diseases Working Party (ADWP) recommend AHSCT as a treatment option for MS patients who have failed high-efficacy DMTs 1.

Treatment Recommendations

• AHSCT is recommended for MS patients who have failed high-efficacy DMTs, particularly those with aggressive or rapidly evolving disease 1.
• The choice of conditioning protocol should be individualized based on the patient's disease characteristics and medical history, with intermediate-intensity protocols such as BEAM-ATG or cyclophosphamide-ATG recommended for most patients 1.
• Patients should be carefully selected and monitored for potential adverse events, and rehabilitation and supportive care should be provided as needed 1.

From the Research

Overview of the DISCO Trial

• The DISCO trial, also known as the DISCOMS (DISCOntinuation of disease-modifying therapies in multiple sclerosis) trial, is a randomized clinical trial that investigated the discontinuation of disease-modifying therapies (DMTs) in older, stable adults with multiple sclerosis (MS) 2.
• The trial aimed to determine whether discontinuing DMTs in this population was not inferior to continuing DMTs.

Results of the DISCO Trial

• The results of the DISCOMS trial showed that relapses were rare in both groups, and most new disease activity was one to two new brain magnetic resonance imaging (MRI) lesions unassociated with clinical changes 2.
• The DISCOMS extension study, which followed patients who completed the original trial, found that there were no relapses, and new brain MRI lesions were uncommon during the extension period 2.
• The time from primary trial entry to disease event was significantly shorter for subjects in the discontinue group (p = 0.043 from log-rank test) 2.

Comparison with Other Studies

• Other studies have investigated the efficacy and safety of DMTs in patients with MS, including the use of immunomodulators and immunosuppressants 3, 4.
• These studies have shown that DMTs can reduce relapse rates and disease progression in patients with MS, but may also be associated with adverse events and treatment discontinuation 3, 4.
• The DISCO trial provides additional information on the safety and efficacy of discontinuing DMTs in older, stable adults with MS, which can inform treatment decisions in this population.

Disease-Modifying Therapies in MS

• DMTs are the mainstay of treatment for relapsing-remitting MS, and several options are available, including interferon beta, glatiramer acetate, natalizumab, and teriflunomide 4, 5.
• The choice of DMT depends on several factors, including the patient's disease activity, medical history, and personal preferences.
• The DISCO trial highlights the importance of considering the potential benefits and risks of continuing or discontinuing DMTs in patients with MS, particularly in older, stable adults.