{"id":"https://openalex.org/W7225324496","doi":"https://doi.org/10.20944/preprints202611.0564.v1","title":"Treatment Exit in Aging Multiple Sclerosis: A Critical Review of Discontinuation, De-Escalation, and Dose Reduction, with Implications for GCC Practice","display_name":"Treatment Exit in Aging Multiple Sclerosis: A Critical Review of Discontinuation, De-Escalation, and Dose Reduction, with Implications for GCC Practice","publication_year":2026,"publication_date":"2026-11-05","ids":{"openalex":"https://openalex.org/W7225324496","doi":"https://doi.org/10.20944/preprints202611.0564.v1"},"language":"en","primary_location":{"id":"doi:10.20944/preprints202611.0564.v1","doi":"https://doi.org/10.20944/preprints202611.0564.v1","is_oa":true,"landing_page_url":"https://doi.org/10.20944/preprints202611.0564.v1","pdf_url":null,"source":{"id":"https://openalex.org/S6309402219","display_name":"Preprints.org","issn_l":null,"issn":null,"is_oa":true,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":null,"host_organization_name":null,"host_organization_lineage":["https://openalex.org/P4310310987"],"host_organization_lineage_names":["Multidisciplinary Digital Publishing Institute"],"type":"repository"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"submittedVersion","is_accepted":false,"is_published":false,"raw_source_name":null,"raw_type":"posted-content"},"volume":null,"type":"preprint","is_traditional":true,"indexed_in":["crossref"],"open_access":{"is_oa":true,"oa_status":"green","oa_url":"https://doi.org/10.20944/preprints202611.0564.v1","any_repository_has_fulltext":true},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5111945354","display_name":"Isa Ahmed Alsharoqi","orcid":"https://orcid.org/0000-0001-8545-4826","observed_orcids":["https://orcid.org/0000-0001-8545-4826"]},"institutions":[],"countries":[],"is_corresponding":true,"raw_author_name":"Isa A. Alsharoqi","raw_affiliation_strings":[],"raw_orcid":"https://orcid.org/0000-0001-8545-4826","affiliations":[]},{"author_position":"middle","author":{"id":"https://openalex.org/A5139550118","display_name":"Abdulla I. Salem Alsharoqi","orcid":"https://orcid.org/0009-0002-3511-7877","observed_orcids":["https://orcid.org/0009-0002-3511-7877"]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Abdulla I Salem Alsharoqi","raw_affiliation_strings":[],"raw_orcid":null,"affiliations":[]},{"author_position":"middle","author":{"id":"https://openalex.org/A5151124389","display_name":"Sayed Mohamed Alsaffar","orcid":null,"observed_orcids":[]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Sayed Mohamed Alsaffar","raw_affiliation_strings":[],"raw_orcid":null,"affiliations":[]},{"author_position":"last","author":{"id":"https://openalex.org/A5069130203","display_name":"Saeed Bohlega","orcid":"https://orcid.org/0000-0002-1046-6571","observed_orcids":["https://orcid.org/0000-0002-1046-6571"]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"Saeed A Bohlega","raw_affiliation_strings":[],"raw_orcid":null,"affiliations":[]}],"institutions":[],"countries_distinct_count":0,"institutions_distinct_count":0,"corresponding_author_ids":["https://openalex.org/A5111945354"],"corresponding_institution_ids":[],"apc_list":null,"apc_paid":null,"fwci":null,"has_fulltext":false,"cited_by_count":0,"citation_normalized_percentile":null,"cited_by_percentile_year":null,"biblio":{"volume":null,"issue":null,"first_page":null,"last_page":null},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T10137","display_name":"Multiple Sclerosis Research Studies","score":1.0,"subfield":{"id":"https://openalex.org/subfields/2728","display_name":"Clinical Neurology"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},"topics":[{"id":"https://openalex.org/T10137","display_name":"Multiple Sclerosis Research Studies","score":1.0,"subfield":{"id":"https://openalex.org/subfields/2728","display_name":"Clinical Neurology"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T11157","display_name":"Chronic Lymphocytic Leukemia Research","score":0.0,"subfield":{"id":"https://openalex.org/subfields/2720","display_name":"Hematology"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T11827","display_name":"Polyomavirus and related diseases","score":0.0,"subfield":{"id":"https://openalex.org/subfields/2730","display_name":"Oncology"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/multiple-sclerosis","display_name":"multiple sclerosis","score":0.9599999785423279},{"id":"https://openalex.org/keywords/disease-modifying-therapy","display_name":"disease-modifying therapy","score":0.6769999861717224},{"id":"https://openalex.org/keywords/treatment-discontinuation","display_name":"treatment discontinuation","score":0.7829999923706055},{"id":"https://openalex.org/keywords/dose-reduction","display_name":"dose reduction","score":0.8360000252723694},{"id":"https://openalex.org/keywords/interval-extension","display_name":"interval extension","score":0.7170000076293945},{"id":"https://openalex.org/keywords/natalizumab","display_name":"natalizumab","score":0.7170000076293945},{"id":"https://openalex.org/keywords/fingolimod","display_name":"fingolimod","score":0.996999979019165},{"id":"https://openalex.org/keywords/anti-cd20-therapy","display_name":"anti-CD20 therapy","score":0.9150000214576721},{"id":"https://openalex.org/keywords/treatment-switching","display_name":"treatment switching","score":0.5130000114440918},{"id":"https://openalex.org/keywords/gulf-cooperation-council","display_name":"Gulf Cooperation Council","score":0.699999988079071},{"id":"https://openalex.org/keywords/older-adults","display_name":"older adults","score":0.6869999766349792},{"id":"https://openalex.org/keywords/disability-progression","display_name":"disability progression","score":0.4779999852180481},{"id":"https://openalex.org/keywords/serious-infection-risk","display_name":"serious infection risk","score":0.5339999794960022},{"id":"https://openalex.org/keywords/minimum-dataset","display_name":"minimum dataset","score":0.32600000500679016}],"concepts":[{"id":"https://openalex.org/C71924100","wikidata":"https://www.wikidata.org/wiki/Q11190","display_name":"Medicine","level":0,"score":0.8310999870300293},{"id":"https://openalex.org/C2776036978","wikidata":"https://www.wikidata.org/wiki/Q425137","display_name":"Fingolimod","level":3,"score":0.5561000108718872},{"id":"https://openalex.org/C177713679","wikidata":"https://www.wikidata.org/wiki/Q679690","display_name":"Intensive care medicine","level":1,"score":0.46959999203681946},{"id":"https://openalex.org/C2779134260","wikidata":"https://www.wikidata.org/wiki/Q12136","display_name":"Disease","level":2,"score":0.46209999918937683},{"id":"https://openalex.org/C2780640218","wikidata":"https://www.wikidata.org/wiki/Q8277","display_name":"Multiple sclerosis","level":2,"score":0.45649999380111694},{"id":"https://openalex.org/C44249647","wikidata":"https://www.wikidata.org/wiki/Q208498","display_name":"Confidence interval","level":2,"score":0.38029998540878296},{"id":"https://openalex.org/C2777286243","wikidata":"https://www.wikidata.org/wiki/Q5591926","display_name":"Grading (engineering)","level":2,"score":0.3637000024318695},{"id":"https://openalex.org/C535046627","wikidata":"https://www.wikidata.org/wiki/Q30612","display_name":"Clinical trial","level":2,"score":0.36329999566078186},{"id":"https://openalex.org/C2781004633","wikidata":"https://www.wikidata.org/wiki/Q386119","display_name":"Natalizumab","level":3,"score":0.3544999957084656},{"id":"https://openalex.org/C2778715236","wikidata":"https://www.wikidata.org/wiki/Q55622662","display_name":"Discontinuation","level":2,"score":0.3239000141620636},{"id":"https://openalex.org/C203092338","wikidata":"https://www.wikidata.org/wiki/Q1340863","display_name":"Clinical endpoint","level":3,"score":0.3010999858379364},{"id":"https://openalex.org/C183905921","wikidata":"https://www.wikidata.org/wiki/Q1038757","display_name":"Multiple comparisons problem","level":2,"score":0.2935999929904938},{"id":"https://openalex.org/C160798450","wikidata":"https://www.wikidata.org/wiki/Q4230870","display_name":"Concordance","level":2,"score":0.2793999910354614},{"id":"https://openalex.org/C168563851","wikidata":"https://www.wikidata.org/wiki/Q1436668","display_name":"Randomized controlled trial","level":2,"score":0.2786000072956085},{"id":"https://openalex.org/C30036603","wikidata":"https://www.wikidata.org/wiki/Q17125150","display_name":"Severity of illness","level":2,"score":0.2547000050544739},{"id":"https://openalex.org/C2987370644","wikidata":"https://www.wikidata.org/wiki/Q7836903","display_name":"Treatment effect","level":2,"score":0.2540000081062317},{"id":"https://openalex.org/C120195587","wikidata":"https://www.wikidata.org/wiki/Q2138790","display_name":"Absolute risk reduction","level":3,"score":0.2538999915122986},{"id":"https://openalex.org/C2780035454","wikidata":"https://www.wikidata.org/wiki/Q8386","display_name":"Drug","level":2,"score":0.2531999945640564}],"mesh":[],"locations_count":1,"locations":[{"id":"doi:10.20944/preprints202611.0564.v1","doi":"https://doi.org/10.20944/preprints202611.0564.v1","is_oa":true,"landing_page_url":"https://doi.org/10.20944/preprints202611.0564.v1","pdf_url":null,"source":{"id":"https://openalex.org/S6309402219","display_name":"Preprints.org","issn_l":null,"issn":null,"is_oa":true,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":null,"host_organization_name":null,"host_organization_lineage":["https://openalex.org/P4310310987"],"host_organization_lineage_names":["Multidisciplinary Digital Publishing Institute"],"type":"repository"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"submittedVersion","is_accepted":false,"is_published":false,"raw_source_name":null,"raw_type":"posted-content"}],"best_oa_location":{"id":"doi:10.20944/preprints202611.0564.v1","doi":"https://doi.org/10.20944/preprints202611.0564.v1","is_oa":true,"landing_page_url":"https://doi.org/10.20944/preprints202611.0564.v1","pdf_url":null,"source":{"id":"https://openalex.org/S6309402219","display_name":"Preprints.org","issn_l":null,"issn":null,"is_oa":true,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":null,"host_organization_name":null,"host_organization_lineage":["https://openalex.org/P4310310987"],"host_organization_lineage_names":["Multidisciplinary Digital Publishing Institute"],"type":"repository"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"submittedVersion","is_accepted":false,"is_published":false,"raw_source_name":null,"raw_type":"posted-content"},"sustainable_development_goals":[{"id":"https://metadata.un.org/sdg/3","score":1.0,"display_name":"Good health and well-being"}],"study_designs":[],"awards":[],"funders":[],"has_content":{"grobid_xml":false,"pdf":false},"content_urls":null,"referenced_works_count":0,"referenced_works":[],"related_works":["https://openalex.org/W4393902452","https://openalex.org/W4414112532","https://openalex.org/W4403951643","https://openalex.org/W4389446080","https://openalex.org/W7160432466","https://openalex.org/W2791181325","https://openalex.org/W4386988771","https://openalex.org/W4409234520","https://openalex.org/W3038897656","https://openalex.org/W7213113634"],"abstract_inverted_index":{"Background:":[0],"Aging":[1],"and":[2,17,62,87,104,171,190,197,227,296,313,315,338,370,383],"prolonged":[3],"disease":[4,124],"stability":[5],"prompt":[6],"reassessment":[7,302,392],"of":[8,106,129,133,141,175,207,385],"multiple":[9],"sclerosis":[10],"disease-modifying":[11],"therapy.":[12],"Discontinuation,":[13],"switching,":[14],"dose":[15,267],"reduction":[16,244],"interval":[18],"extension":[19],"are":[20],"distinct":[21],"strategies.":[22],"Stability":[23],"during":[24],"treatment":[25,57,210,225,233,249,283,381,394],"may":[26],"reflect":[27],"reduced":[28],"inflammatory":[29,158,331,376],"activity,":[30,187,332],"continuing":[31],"drug":[32],"effects,":[33],"or":[34,113,352],"both;":[35],"chronological":[36],"age":[37,179],"alone":[38],"cannot":[39,262],"establish":[40,240],"that":[41,290],"withdrawal":[42],"will":[43],"preserve":[44],"control.":[45],"Objective:":[46],"To":[47],"critically":[48],"assess":[49],"treatment-exit":[50],"evidence,":[51],"reconcile":[52],"apparently":[53],"conflicting":[54],"findings,":[55],"distinguish":[56,316,390],"effects":[58],"from":[59,319,393],"prognostic":[60],"associations,":[61],"examine":[63],"implications":[64],"for":[65,258,329],"Gulf":[66],"Cooperation":[67],"Council":[68],"(GCC)":[69],"practice.":[70],"Approach:":[71],"A":[72],"targeted,":[73],"web-assisted":[74],"critical":[75],"narrative":[76],"review":[77],"examined":[78],"accessible":[79],"primary":[80,294],"studies,":[81],"corrections,":[82],"conference":[83],"reports,":[84],"trial":[85],"registrations":[86],"regional":[88,320],"documents":[89],"through":[90],"1":[91],"November":[92],"2026.":[93],"Comparisons":[94],"considered":[95],"population,":[96],"mechanism,":[97],"strategy,":[98],"outcome,":[99],"surveillance,":[100],"residual":[101,223],"exposure,":[102,224,335],"restart":[103],"alignment":[105],"follow-up.":[107],"No":[108],"meta-analysis,":[109],"independent":[110],"duplicate":[111],"screening":[112],"formal":[114],"certainty":[115],"grading":[116],"was":[117,150],"performed.":[118],"Principal":[119],"findings:":[120],"In":[121],"DISCOMS,":[122],"new":[123],"activity":[125,159],"occurred":[126],"in":[127,160,167,218,245,275],"12.2%":[128],"discontinuers":[130,162],"versus":[131,163],"4.7%":[132],"continuers":[134],"over":[135],"two":[136],"years:":[137],"an":[138],"absolute":[139,311],"difference":[140],"7.5":[142],"percentage":[143],"points":[144],"(95%":[145],"confidence":[146],"interval,":[147],"0.6\u201315.0);":[148],"non-inferiority":[149],"not":[151,239],"established.":[152],"DOT-MS":[153],"stopped":[154],"early":[155,201],"after":[156],"significant":[157],"8/45":[161],"0/44":[164],"continuers.":[165],"Differences":[166],"eligibility,":[168],"MRI":[169],"thresholds":[170],"follow-up":[172],"prevent":[173],"attribution":[174],"these":[176],"findings":[177,257],"to":[178,265],"alone.":[180],"Selected":[181],"older-adult":[182],"cohorts":[183,280],"report":[184],"limited":[185],"relapse":[186],"but":[188],"disability":[189,333],"patient-reported":[191],"outcomes":[192,312],"remain":[193],"less":[194],"certain.":[195],"Natalizumab":[196],"fingolimod":[198],"cessation":[199,213],"carry":[200],"reactivation":[202],"concerns":[203],"requiring":[204],"explicit":[205],"consideration":[206],"the":[208,357],"subsequent":[209],"pathway.":[211],"Anti-CD20":[212],"studies":[214,369],"show":[215],"sustained":[216],"suppression":[217],"some":[219],"selected":[220],"populations,":[221],"although":[222],"selection":[226],"imprecision":[228],"limit":[229],"conclusions":[230],"about":[231],"durable":[232],"independence.":[234],"The":[235],"included":[236],"evidence":[237,274,295],"does":[238],"a":[241,349],"reliable":[242],"comparative":[243,368],"serious":[246,379],"infection":[247],"following":[248],"exit.":[250],"Lower-efficacy":[251],"switching":[252],"can":[253],"increase":[254],"recurrence,":[255,377],"while":[256],"specified":[259,305],"extended":[260],"intervals":[261],"be":[263],"generalized":[264],"arbitrary":[266],"reductions.":[268],"Kuwait":[269],"supplies":[270],"direct":[271],"natalizumab":[272],"interval-extension":[273],"younger":[276],"adults;":[277],"other":[278],"GCC":[279,372],"mainly":[281],"inform":[282],"context.":[284],"Regional":[285],"guidance":[286],"offers":[287],"practical":[288],"criteria":[289],"require":[291],"appraisal":[292],"against":[293],"local":[297],"monitoring":[298],"conditions.":[299],"Conclusions:":[300],"Treatment":[301],"should":[303,374,389],"compare":[304],"alternatives":[306],"with":[307],"continuation,":[308],"communicate":[309],"relevant":[310],"uncertainty,":[314],"estimated":[317],"benefit\u2013harm":[318],"applicability.":[321],"An":[322],"author-proposed":[323],"framework":[324],"organizes":[325],"patient":[326],"goals,":[327],"reasons":[328],"change,":[330],"trajectory,":[334],"harms,":[336],"observation":[337],"reassessment.":[339],"Its":[340],"accompanying":[341],"minimum":[342],"dataset":[343],"supports":[344],"prospective":[345],"evaluation":[346,388],"without":[347],"assigning":[348],"risk":[350],"score":[351],"universal":[353],"stopping":[354],"threshold.":[355],"Neither":[356],"framework\u2019s":[358],"feasibility":[359],"nor":[360],"its":[361],"clinical":[362],"utility":[363],"has":[364],"been":[365],"validated.":[366],"Mechanism-specific":[367],"coordinated":[371],"research":[373],"evaluate":[375],"disability,":[378],"infections,":[380],"burden":[382],"continuity":[384],"care.":[386],"Such":[387],"elective":[391],"interruptions":[395],"caused":[396],"by":[397],"changing":[398],"access":[399],"arrangements.":[400]},"counts_by_year":[],"updated_date":"2026-11-09T13:22:03.289127","created_date":"2026-11-06T00:00:00"}
