In the world of Multiple Sclerosis (MS), we are often taught that treatment is “for life.” However, research is moving forward and today poses a bold question: in stable patients over the age of 55, could stopping treatment actually be beneficial?
To find out, I met with Professor Collongues, a neurologist and national coordinator of the TWINS study. Today, the study includes 22 centres and counts around 70 inclusions in France.
What is Multiple Sclerosis (MS)?
Multiple Sclerosis (MS) is a chronic autoimmune disease that affects the central nervous system (the brain and spinal cord). To put it simply: the body’s defense system mistakenly attacks myelin, the protective sheath surrounding the nerves. This disrupts the transmission of messages between the brain and the rest of the body, causing various symptoms such as vision, motor, or sensory issues.
Why consider stopping treatment?
This is the core of the TWINS study. As we age, our immune system grows older: this is known as immunosenescence. In patients whose disease has been stable for more than 5 years, meaning no relapses and no new lesions visible on MRI, MS-related inflammation tends to decrease naturally.
“In these patients with a good prognosis and a stability of at least 5 years, the benefit-risk ratio is favourable” notes Prof. Collongues.
What are the benefits of stopping treatment?
- Improved quality of life: No more daily injections or medication and their side effects (fatigue and digestive issues, for example).
- Increased safety: Reducing the long-term risk of infections associated with disease-modifying therapies.
- A better balance: Ensuring that the treatment does not weigh heavier on daily life than the disease itself.
Who is behind the TWINS study?
Like many clinical trials, this study requires complex logistics backed by a large team of specialists. In the TWINS study, Prof. Collongues acts as the principal investigator neurologist and coordinates a multidisciplinary team managing the trial. This team notably includes research nurses, clinical trial coordinators (CTCs), and laboratory technicians to analyse blood samples.
These samples allow researchers to measure two blood biomarkers (sNFL and sGFAP) that could signal a return of disease activity even before symptoms or visible signs appear on an MRI. The objective is to verify whether these biomarkers can better anticipate the progression of MS. By cross-referencing these blood analyses with MRIs and the patients’ overall health, researchers hope to guide medical decisions more precisely through personalised, less invasive, and highly secure monitoring.
Concretely, what does it look like for the patient?
The TWINS trial is randomised and open-label. This means that participants are divided into two groups: one continues their usual treatment, while the other stops it (there is no placebo here). Throughout the study, patient safety comes first.
Each patient receives ultra-close monitoring; every 6 months, patients benefit from a blood test, an MRI, and a medical consultation to evaluate any potential clinical signs and their quality of life. For instance, clinicians use the SEP59 scale to assess the impact on daily life: fatigue, pain, social life, libido… The goal is to see whether stopping the treatment allows patients to feel “better” overall.
If the slightest clinical sign or a new lesion appears on the MRI, the patient immediately exits the trial and resumes their background treatment with their usual neurologist. This is a very fast and reactive procedure.
At the end of the study, the patient decides, with the advice of their neurologist, whether or not they wish to resume their treatment.
“A therapeutic protocol is, above all, a message of hope. It is designed exclusively in the best interest of the patient,” reminds the Professor.
Participating in a study like TWINS means helping science understand when the body can “take back control.” It is a quiet revolution that places quality of life right at the centre of care.
If you wish to read up more on the TWINS study follow this link: Evaluation de l’arrêt thérapeutique dans la sclérose en plaques rémittente-récurrente chez les patients stables de 55 ans et plus : une étude multicentrique, randomisée, contrôlée, en ouvert. | Hôpital Beaujon AP-HP
And if you’re interested in being kept to up to date on research news and opportunities, sign up to our community below: