Presentation: Top Seminars Sorrento Italy

Preventing end-organ damage: the new therapeutic target in MS. #MSBlog #MSResearch

“I am in Sorrento, Italy, speaking at Giancarlo Comi’s annual Top Seminars MS meeting; Sorrento is beautiful. Unfortunately, I arrived at 23h30 last night and have to leave at 14h30 this afternoon. The following is the programme. I was asked to speak on biomarkers and clinical outcomes. I decided to use the talk to show how we will be incorporating biomarkers (brain atrophy and spinal fluid neurofilament levels) into clinical practice to treat-2-target of preventing end-organ damage. The latter is a new aim and will rely in incorporating brain atrophy and spinal fluid neurofilament levels into the definition of NEDA. I use my renal analogy of protecting the kidney and renal function to make the point that we need to protect the brain. In other words we need to adopt the treatment philosophy nephrologists have evolved to treat kidney disease, for the brain. In other words we need zero tolerance when it comes to brain damage.”

About the author

Prof G

Professor of Neurology, Barts & The London. MS & Preventive Neurology thinker, blogger, runner, vegetable gardener, husband, father, cook and wine & food lover.


  • Prof G, what is the general feedback you are getting from your fellow ms colleagues regarding NEDA and early aggressive treatment? Are people on board, sceptical, sitting on the fence? Do other ms specialists subscribe to these concepts? Also, what is the difference between NEDA and DAF?

    • Re: "Prof G, what is the general feedback you are getting from your fellow ms colleagues regarding NEDA and early aggressive treatment?"

      Most people accept NEDA as a aim, but when it comes to practicing it's a different story. For example, one delegate said to me that based on the CARE-MS 1 study he didn't think alemtuzumab was better than Rebif in drug-naive MSers. This was based on the fact that the difference between the tow treatment groups was not significantly different. I asked him was he focusing on the tip of the iceberg and not thinking about what is happening below the surface? He then conceded that yes, alemtuzumab was more effective at preventing end-organ damage. I think over time T2T-NEDA will become the norm.

      DAF and NEDA are essentially the same thing; the problem with DAF is that implies we know everything about the disease, which we don't. NEDA allows the definition to evolve with time as we learn more and it adopts a strategy from oncology (NEDD – no evidence of detectable disease). Oncologists have learnt a lot over the years; I don't believe in re-inventing wheels.

    • At the moment achievement of NEDA seems to be based on using highly effective dmts eg alemtuzumab. How will neuroprotective agents (some currently being trialled) and remyelination agents fit with the strategy of achieving NEDA?

  • My late wife had PMS & having a number of seizure's she was hospitalised, test showed very high sodium levels & organ failure.
    She passed away 15 days peacefully in hospital.

    • Re: "She passed away 15 days peacefully in hospital."

      I am very sorry to hear your news. Please accept our condolences. A very high sodium level suggests she may have been dehydrated.

By Prof G



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