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Mult Scler. 2018 Oct;24(12):1569-1577. doi: 10.1177/1352458518798147. Epub 2018 Sep 20.

Silent lesions on MRI imaging - Shifting goal posts for treatment decisions in multiple sclerosis.

Author information

1
Department of Neurology, John Hunter Hospital, Newcastle, NSW, Australia.
2
Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden/ Burnet Institute for Medical Research and Public Health, Melbourne, VIC, Australia.
3
Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy/ IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.
4
KTU Medical Faculty Farabi Hospital, Trabzon, Turkey.
5
Azienda Ospedaliera di Rilievo Nazionale San Giuseppe Moscati Avellino, Avellino, Italy.
6
UOC Neurologia, Azienda Sanitaria Unica Regionale Marche-AV3, Macerata, Italy.
7
Neuro Rive-Sud, Greenfield Park, QC, Canada.
8
Department of Medicine and Surgery, Unit of Neuroscience, University of Parma, Parma, Italy.
9
Hospital Universitario Virgen Macarena, Seville, Spain.
10
MS and Neuroimmunology Research, Central Clinical School, Monash University, MS and Neuroimmunology Service, Alfred Health, Australia.
11
Hospital de Galdakao-Usansolo, Galdakao, Spain.
12
Department of Neurology, Royal Prince Alfred Hospital, Sydney, NSW, Australia/ Brain and Mind Research Institute, Sydney, NSW, Australia.
13
Hotel-Dieu de Montreal, Montreal, QC, Canada.
14
Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari, Bari, Italy.
15
CISSS Chaudiere-Appalache, Levis, Canada.
16
CHUM Hopital Notre Dame, Montreal, Canada.
17
Department of Neuroscience, Azienda Ospedaliera Universitaria, Modena, Italy.
18
Division of Neurology, Department of Medicine, Amiri Hospital, Sharq, Kuwait.
19
Zuyderland Ziekenhuis, Sittard, The Netherlands.
20
Westmead Hospital, Sydney, NSW, Australia.
21
CORe, Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia/ Department of Neurology, Royal Melbourne Hospital, Parkville, VIC, Australia.
22
Cliniques Universitaires Saint-Luc, Woluwe-Saint-Lambert, Belgium.
23
Department of Neurology, John Hunter Hospital, Newcastle, NSW, Australia/ School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia.

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.

KEYWORDS:

Disease-modifying therapy; magnetic resonance imaging; subclinical lesions

PMID:
30234431
DOI:
10.1177/1352458518798147

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