Silent lesions on MRI imaging – Shifting goal posts for treatment decisions in multiple sclerosis. (October 2018)

• Record Type: Journal Article
• Authors: Min, Myintzu; Spelman, Tim; Lugaresi, Alessandra; Boz, Cavit; Spitaleri, Daniele LA; Pucci, Eugenio; Grand'Maison, Francois; Granella, Franco; Izquierdo, Guillermo; Butzkueven, Helmut; Sanchez-Menoyo, Jose Luis; Barnett, Michael; Girard, Marc; Trojano, Maria; Grammond, Pierre; Duquette, Pierre; Sola, Patrizia; Alroughani, Raed; Hupperts, Raymond; Vucic, Steve; Kalincik, Tomas; Van pesch, Vincent; Lechner-Scott, Jeannette
• Is Part Of: Multiple sclerosis. Volume 24:Number 12(2018)
• Page Start: 1569
• Page End: 1577
• Publication Date: 2018-10
• Subjects: Disease-modifying therapy -- magnetic resonance imaging -- subclinical lesions; Central nervous system -- Diseases -- Periodicals; Myelin sheath -- Diseases -- Periodicals; Inflammation -- Periodicals; Multiple sclerosis -- Periodicals; Central Nervous System Diseases -- Periodicals; Demyelinating Diseases -- Periodicals; Inflammation -- Periodicals; Multiple Sclerosis -- Periodicals; Système nerveux central -- Maladies -- Périodiques; Gaine de myéline -- Maladies -- Périodiques; Inflammation (Pathologie) -- Périodiques; Sclérose en plaques -- Périodiques; Electronic journals; 616.834005
• DOI: 10.1177/1352458518798147
• Languages: English
• ISSNs: 1352-4585

Abstract

Background: The current best practice suggests yearly magnetic resonance imaging (MRI) to monitor treatment response in multiple sclerosis (MS) patients. Objective: To evaluate the current practice of clinicians changing MS treatment based on subclinical new MRI lesions alone. Methods: Using MSBase, an international MS patient registry with MRI data, we analysed the probability of treatment change among patients with clinically silent new MRI lesions. Results: A total of 8311 MRI brain scans of 4232 patients were identified. Around 26.9% (336/1247) MRIs with one new T2 lesion were followed by disease-modifying therapy (DMT) change, increasing to 50.2% (129/257) with six new T2 lesions. DMT change was twice as likely with new T1 contrast enhancing compared to new T2 lesions odds ratio (OR): 2.43, 95% confidence interval (CI): 2.00–2.96 vs OR: 1.26 (95% CI: 1.22–1.29). DMT change with new MRI lesions occurred most frequently with 'injectable' DMTs. The probability of switching therapy was greater only after high-efficacy therapies became available in 2007 (after, OR: 1.43, 95% CI: 1.28–1.59 vs before, OR: 0.98, 95% CI: 0.520–1.88). Conclusion: MS clinicians rely increasingly on MRI alone in their treatment decisions, utilizing low thresholds (1 new T2 lesion) for optimizing MS therapy. This signals a shift towards no evidence of disease activity (NEDA)-3 since high-efficacy therapies became available.