en Neurology Neurology Original Article Original Article <span style="font-size:14px;"><span style="font-family:Times New Roman;"><span style="line-height:14pt"><b><i><span style="color:blue">Background</span></i></b><i><span style="color:blue">:</span></i> Disease-modifying therapies (DMTs) are the mainstay of relapsing-remitting multiple sclerosis (RRMS) treatment. Their efficacy decreases with age, while risks such as infections increase. This study aimed to evaluate the safety and clinical outcomes of DMT discontinuation in patients with RRMS aged 55 years and older.</span><br> <span style="line-height:14pt"><b><i><span style="color:blue">Methods:</span></i></b> We conducted a randomized clinical trial including 178 patients with RRMS aged &ge;55 years, EDSS &le;3, and no relapses or MRI activity for at least 5 years. Patients were randomized to continue DMTs (n=89) or discontinue (n=89). Clinical relapses, EDSS scores, and MRI activity were assessed over 24 months.</span><br> <span style="line-height:14pt"><b><i><span style="color:blue">Results:</span></i></b> Relapses occurred in 9 (10.7%) patients in the continuation group and 12 patients (14.3%) in the discontinuation group (Risk Ratio [RR] = 1.33, 95% CI: 0.60 to 2.98; P=0.48). MRI activity was detected in 6 patients (7.1%) continuing DMTs and 9 (10.7%) patients who discontinued (RR = 1.50, 95% CI: 0.56 to 4.02; P=0.41). EDSS scores increased slightly in both groups during the first year. At 24 months, the mean EDSS was 1.59 (&plusmn;0.74) in the continuation group and 1.36 (&plusmn;0.74) in the discontinuation group, with no statistically significant difference between groups (mean difference = 0.23, 95% CI: -0.002 to 0.46; P=0.05).</span><br> <span style="line-height:14pt"><b><i><span style="color:blue">Conclusion</span></i></b><i><span style="color:blue">:</span></i> In patients aged &ge;55 years with stable RRMS, discontinuation of DMTs did not significantly increase relapses, disability progression, or MRI activity compared with continuation. These findings suggest that DMT discontinuation may be a safe and reasonable option for selected older patients. Larger, multicenter studies with longer follow-ups are warranted.<span style="font-size:10.0pt"></span></span></span></span><br> &nbsp; Multiple sclerosis, Disease-modifying therapy, Recurrence, Aging, Disability 589 594 http://caspjim.com/browse.php?a_code=A-10-1319-8&slc_lang=en&sid=1 Sajjad Daneshyar s.danshyar72@yahoo.com 100319475328460057825 100319475328460057825 Yes Department of Neurology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran Masoud Ghiasian masoud_ghiasian@yahoo.com 100319475328460057826 100319475328460057826 No Department of Neurology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran Salman khazaei salman.khazaei61@gmail.com 100319475328460057827 100319475328460057827 No Reseach Center for Health Sciences, Hamadan University of Medical Sciences, Hamadan, Iran Kimia Alborzi k.alborzi1372@gmail.com 100319475328460057828 0009-0002-6148-8655 No Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science) Employment Maryam Ebadi masomeebadi72@gmail.com 100319475328460057829 100319475328460057829 No Department of Neurology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran