- Title
- Silent lesions on MRI imaging - Shifting goal posts for treatment decisions in multiple sclerosis
- Creator
- Min, Myintzu; Spelman, Tim; Sanchez-Menoyo, Jose Luis; Barnett, Michael; Girard, Marc; Trojano, Maria; Grammond, Pierre; Duquette, Pierre; Sola, Patrizia; Alroughani, Raed; Hupperts, Raymond; Vucic, Steve; Lugaresi, Alessandra; Kalincik, Tomas; Van pesch, Vincent; Lechner-Scott, Jeannette; Boz, Cavit; Spitaleri, Daniele L. A.; Pucci, Eugenio; Grand'Maison, Francois; Granella, Franco; Izquierdo, Guillermo; Butzkueven, Helmut
- Relation
- Multiple Sclerosis Journal Vol. 24, Issue 12, p. 1569-1577
- Publisher Link
- http://dx.doi.org/10.1177/1352458518798147
- Publisher
- Sage
- Resource Type
- journal article
- Date
- 2018
- Description
- 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.
- Subject
- disease-modifying therapy; magnetic resonance imaging; subclinical lesions
- Identifier
- http://hdl.handle.net/1959.13/1441070
- Identifier
- uon:41309
- Identifier
- ISSN:1352-4585
- Language
- eng
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