Minimal evidence of disease activity (MEDA) in relapsing-remitting multiple sclerosis. Issue 3 (23rd January 2020)

• Record Type: Journal Article
• Authors: Prosperini, Luca; Mancinelli, Chiara; Haggiag, Shalom; Cordioli, Cinzia; De Giglio, Laura; De Rossi, Nicola; Galgani, Simonetta; Rasia, Sarah; Ruggieri, Serena; Tortorella, Carla; Pozzilli, Carlo; Gasperini, Claudio
• Is Part Of: Journal of neurology, neurosurgery and psychiatry. Volume 91:Issue 3(2020)
• Page Start: 271
• Page End: 277
• Publication Date: 2020-01-23
• Subjects: multiple sclerosis -- MRI -- treatment response -- NEDA -- MEDA; Neurology -- Periodicals; Nervous system -- Surgery -- Periodicals; Psychiatry -- Periodicals; 616.8
• DOI: 10.1136/jnnp-2019-322348
• Languages: English
• ISSNs: 0022-3050

Abstract

Abstract : Objective: This study aimed to define the minimal evidence of disease activity (MEDA) during treatment that can be tolerated without exposing patients with relapsing-remitting multiple sclerosis at risk of long-term disability. Methods: We retrospectively collected data of patients followed up to 10 years after starting interferon beta or glatiramer acetate. Survival analyses explored the association between the long-term risk of reaching an Expanded Disability Status Scale≥6.0 and early clinical and MRI activity assessed after the first and second year of treatment. Early disease activity was classified by the so-called 'MAGNIMS score' ( low : no relapses and <3 new T2 lesions; medium : no relapses and ≥3 new T2 lesions or 1 relapse and 0–2 new T2 lesions; high : 1 relapse and ≥3 new T2 lesions or ≥2 relapses) and the absence or presence of contrast-enhancing lesions (CELs). Results: At follow-up, 148/1036 (14.3%) patients reached the outcome: 61/685 (8.9%) with low score (reference category), 57/241 (23.7%) with medium score (HR=1.94, p=0.002) and 30/110 (27.3%) with high score (HR=2.47, p<0.001) after the first year of treatment. In the low score subgroup, the risk was further reduced in the absence (49/607, 8.1%) than in the presence of CELs (12/78, 15.4%; HR=2.11, p=0.01). No evident disease activity and low score in the absence of CELs shared the same risk (p=0.54). Similar findings were obtained even after the second year of treatment. Conclusions: Early marginal MRI activity of one to two new T2 lesions, in the absence of both relapses and CELs, is associated with a minor risk of future disability, thus representing a simple and valuable definition for MEDA.