Initiating a DMT as soon as possible after diagnosis may optimise the DMT’s effect, before any disability or nerve damage has built up; DMTs are unlikely to reverse established symptoms. There is also evidence to indicate that DMTs’ treatment effects can wear off in the longer-term, again supporting the view that starting a DMT early will reduce the potential for disabling symptoms developing later on.⁷

An aim in RRMS treatment with DMTs is to reach a point where there is freedom from disease activity regarded as ‘no evidence of disease activity’ (NEDA). This means with:⁷

• ·       no relapses

• ·       no increase in disability, and

• ·       no new or active/enhancing lesions as seen in MRI scans.

This can be referred to as NEDA-3, or with a fourth component of no further brain atrophy, NEDA-4. For people with progressive MS, the goal of ‘no evidence of progression or active disease’ (NEPAD) may be more appropriate than NEDA.

DMTs can allow people with RRMS to have long periods without a relapse, potentially maintaining a state of NEDA-3 or NEDA-4 for years. It may come to a point where the length of remission and the impact of DMT side effects on the patient’s quality of life raises the question of whether the DMT could or should be discontinued.¹⁴

Relapse is likely to recur after stopping a DMT, especially before the mid 50s, but there is some support for stopping DMTs in older people if they have been on DMT for many years without any new inflammatory disease activity.^14,16