Relapses and MRI Activity Predict MS Treatment Response

The amount of MRI activity to be tolerated remains a matter of debate. To investigate this question, Sormani and colleagues examined a large amount of data from the MRI in MS network about patients treated with interferon beta. The investigators determined that patients with two or more relapses or one relapse and three or more new T2 lesions were at highest risk of disability worsening. The investigators initially classified 130 patients as being at high risk, but the final number of patients who had sustained disability worsening was more than 300. “So, this score suffered from a low sensitivity,” said Dr. Prosperini.

Lesion Location May Predict Outcomes

“Another important question is the topography of the new lesions,” he continued. Galassi et al presented a study at ECTRIMS of 390 patients with relapsing-remitting MS who initiated treatment with interferon beta and were assessed at one year. Follow-up lasted for four years. When the researchers chose disability worsening as their final outcome and performed multivariable Cox regression analysis, they found that new infratentorial lesions and new spinal cord lesions were independent predictors of disability worsening. Lesion count, however, did not contribute to model fit.

For patients with a good prognosis, early and safe treatment should be the goals, said Dr. Prosperini. Early and effective treatment should be the goals for patients with a bad prognosis, he added. “Consider induction strategy in aggressive MS, even if it’s the less frequent phenotype. After treatment starts, we should assess patients correctly and regularly.”

—Erik Greb