Guidelines from the American Academy of Neurology (AAN) recommend considering switching DMT in patients with progressive MS who, in the past year have experienced ≥1 relapse, increased disability, or ≥2 unequivocally new MRI-detected lesions. The choice of DMT varies with the individual patient, weighing factors such as comorbidities and concurrent medications, AE tolerance, level of disease activity, and any patient preference based on lifestyle issues. Although many patients prefer oral medication, infusions or injections may be preferable for others. For most patients, the benefits of infusion therapies outweigh the risks when proper risk mitigation strategies are employed. AAN guidelines state that clinicians may advise stopping for individuals at low risk of relapse and who have not been ambulatory for ≥2 years.

References:
Rae-Grant A et al. Neurology. 2018;90:777-788.