When a person with relapsing–remitting MS starts a new treatment, it is important to know as soon as possible whether the treatment is working. To make this judgement, clinicians can consider relapses, disability progression and MRI brain scans, but which of these measures is the most informative?
A new systematic review,1 published online on 29 December 2015, suggests that MRI-based measures are currently the most accurate short-term criteria for predicting long-term outcomes. However, the authors stress that more sensitive measures are needed.
The study examined 45 published articles and compared common short-term (≤ 1 year) predictors of MS disease activity with the long-term (≥ 2 years) outcomes. The most predictive criteria were those based on MRI scans alone or on MRI scans and clinical measures combined. New or enlarged T2 lesions were found to be a more accurate MRI-based predictor than gadolinium-enhancing lesions, but both were much more accurate predictors than clinical measures alone.
This study adds to other evidence supporting the recommendation of the Brain health: time matters in multiple sclerosis report that clinicians should ‘include evidence from monitoring via regular clinical evaluation and scheduled/unscheduled MRI brain scans in any definitions of disease activity or suboptimal response’.
1. Río J et al. J Neurol Sci 2016;361;158–67