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Silent lesions on MRI imaging - Shifting goal posts for treatment decisions in multiple sclerosis
- Min, M (author)
- Spelman, T (author)
- Lugaresi, A (author)
- show more...
- Boz, C (author)
- Spitaleri, DLA (author)
- Pucci, E (author)
- Grand'Maison, F (author)
- Granella, F (author)
- Izquierdo, G (author)
- Butzkueven, H (author)
- Sanchez-Menoyo, JL (author)
- Barnett, M (author)
- Girard, M (author)
- Trojano, M (author)
- Grammond, P (author)
- Duquette, P (author)
- Sola, P (author)
- Alroughani, R (author)
- Hupperts, R (author)
- Vucic, S (author)
- Kalincik, T (author)
- Van pesch, V (author)
- Lechner-Scott, J (author)
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- 2018-09-20
- 2018
- English.
- In: Multiple sclerosis (Houndmills, Basingstoke, England). - : SAGE Publications. - 1477-0970 .- 1352-4585. ; 24:12, s. 1569-1577
- Journal article (peer-reviewed)
Abstract
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- 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.
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- Min, M
- Spelman, T
- Lugaresi, A
- Boz, C
- Spitaleri, DLA
- Pucci, E
- show more...
- Grand'Maison, F
- Granella, F
- Izquierdo, G
- Butzkueven, H
- Sanchez-Menoyo, ...
- Barnett, M
- Girard, M
- Trojano, M
- Grammond, P
- Duquette, P
- Sola, P
- Alroughani, R
- Hupperts, R
- Vucic, S
- Kalincik, T
- Van pesch, V
- Lechner-Scott, J
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- Multiple scleros ...
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- Karolinska Institutet
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