“You may have heard me banging on endlessly about treating-2-target of NEDA (no evidence of disease activity) and my ZeTo or zero tolerance strategy of not tolerating disease activity, either clinically or on MRI. The study below supports this strategy in that MSers on IFNbeta who have either clinical or subclinical (MRI only) evidence of disease activity do much worse in terms of disability worsening.”
“In the past I have spoken about the MS Treatment doughnut, which this study illustrates very well. If you are failing DMTs on MRI criteria only, and not clinically, you will not fulfill contemporary criteria to have your treatment escalated. In other words the EMA, and NICE in the UK, do not accept MRI activity as an indication that you are failing treatment. This is why I campaigning to reclassify MRI activity as subclinical relapses. If we start referring to the development of new lesions as relapses, healthcare payers may start to accept MRI activity (new or enlarging T2 lesions and Gad-enhancing lesions) as a surrogate for relapses.”
Epub: Prosperini et al. Interferon beta failure predicted by EMA criteria or isolated MRI activity in multiple sclerosis. Mult Scler. 2013 Sep.
OBJECTIVE: The objective of this paper is to investigate four-year outcomes of interferon beta (IFNB)-treated MSers according to their clinical or magnetic resonance imaging (MRI) activity status at first year of treatment.
METHODS: A total of 370 MSers with MS duration ≤5 years before IFNB start were followed-up for four years. The optimal threshold for one-year MRI activity that more accurately predicted subsequent relapses or disability worsening was identified. The risk of relapses and disability worsening after the first year was then estimated by propensity score (PS)-adjusted analyses in MSers fulfilling European Medicines Agency (EMA) criteria for second-line escalation and in those with isolated MRI activity.
RESULTS: A total of 192 (51.9%) MSers relapsed, and 66 (17.8%) worsened in disability from year 1 to 4 of follow-up. The more accurate threshold for one-year MRI activity was the occurrence of ≥1 enhancing or ≥2 new T2-lesions. An increased risk of relapses and disability worsening was found in either MSers fulfilling EMA criteria (hazard ratio (HR) = 3.69, and HR = 6.02) and in those experiencing isolated MRI activity (HR = 3.15, and HR = 5.31) at first year of treatment, when compared with stable MSers (all p values <0.001).
CONCLUSION: The four-year outcomes of patients with isolated MRI activity did not differ from those fulfilling EMA criteria at first year of IFNB treatment.