NEDA-3 may not be enough to save brain

Damasceno A, Damasceno BP, Cendes F. No evidence of disease activity in multiple sclerosis: Implications on cognition and brain atrophy. Mult Scler. 2015. pii: 1352458515604383. [Epub ahead of print]

BACKGROUND:The concept of no evidence of disease activity (NEDA) has emerged as an important outcome measure for multiple sclerosis (MS). However, it is not known if maintaining NEDA has a positive impact on cognition or brain atrophy.

OBJECTIVE:To evaluate NEDA status after two years, addressing its implications on cognition and brain atrophy.
METHODS:Forty-two relapsing-remitting MS patients and 30 controls underwent MRI (3T) and cognitive evaluation (BRB-N). Forty patients performed additional evaluations, after 12 and 24 months. NEDA was defined as the absence of clinical (relapses/disability progression) and MRI activity (new T2/gadolinium-enhancing lesions). Repeated measures and multivariate analyses were performed to assess the contribution of NEDA criteria to GM atrophy.
RESULTS:After two years, 30.8% of the cohort had NEDA. From these, 58.3% still had worsening in ⩾2 cognitive domains. Patients with MRI activity had more cortical thinning and slightly more thalamus volume decrease. Absence of new/enlarging T2 lesions was the only predictor of cortical thinning, subcortical GM and thalamic atrophy rates.
CONCLUSIONS:NEDA status was achieved in a small proportion of our cohort, and did not preclude cognitive deterioration. Absence of MRI activity and especially of new/enlarging T2 lesions was associated with less cortical and subcortical GM atrophy.

Maybe we need to build a model of NEDA-5 to include analysis of cognition. Don’t forget to read the brain health post.;

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  • That is NEDA-6 then:

    1) Relapses
    2) Clinical deterioration (EDSS, others)
    3) Cognitive deterioration
    4) T2 & Gd-enhancing lesions
    5) Brain atrophy
    6) Neurofilament level in the cerebro-spinal fluid

    NEDA will continue to evolve as (i) a concept to better understand MS pathophysiology, (ii) a treatment goal and (iii) an ambition.

  • NEDA is 1, 2, and 4, NEDA-4 is + 5

    NEDA 5 is either 3 or 6 and NEDA 6 would be either 6 or 3 depending on definition of NEDA-5

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