A comprehensive approach to assessing MS disease activity may be important
In MS, clinical and subclinical disease activity can occur early in the disease course and persist throughout the disease1‑3
Detecting Disease Activity
The Impact of Disease Activity on MS Disability
Emerging scientific research shows that a considerable amount of disease activity may elude detection4
Academic research comparing total lesion detection rates of 7‑ and 3‑T MRI revealed 34% more juxtacortical lesions with 7‑T MRI that would have otherwise gone undetected.4
In an MRI study that included 380 MS patients, grey matter lesions were observed at clinical onset and were found in 64% of RRMS patients versus 0% in the healthy control group.5
Cortical demyelination may be present at subclinical levels more widely and earlier than previously recognized.6,7
Even small amounts of subclinical or clinical disease activity can be predictive of future disability, and can result in permanent damage2,8
One or more T2 lesions can lead to
A study* of RRMS patients with sustained disability progression during IFNβ treatment showed that appearance of one or more T2 lesions can increase patients’ risk for disability progression greater than 15-fold, even in the absence of clinical relapses.3
In a study of 45 patients with RRMS, cognitive dysfunction correlated significantly with future progression of overall disability, as measured by EDSS scores over 7 years.9
A greater number of relapses within the first 5 years of MS may indicate a faster progression of disability to EDSS 6.0.10
— Relapses beyond 5 years postonset did not impact progression of EDSS
A study of MS patients on interferon treatment for more than 2 years showed that a 1-point change on EDSS correlated with progression to a more advanced level of disability (EDSS 6.0) at 4 years.8
*Single-center, prospective, observational, postmarketing study of RRMS patients during at least 1 year of treatment with one of the available IFNβ formulations.3
- Polman CH, Reingold SC, Banwell, B, et al. Diagnostic criteria for multiple sclerosis: 2010 revisions to the McDonald criteria. Ann Neurol. 2011(2);69:292-302.
- Scott TF, Hackett CT, Quigley MR, Schramke CJ. Relapsing multiple sclerosis patients treated with disease modifying therapy exhibit highly variable disease progression: a predictive model. Clin Neurol Neurosurg. 2014(127);86-92.
- Prosperini L, Gallo V, Petsas N, Borriello G, Pozzilli C. One-year MRI scan predicts clinical response to interferon beta in multiple sclerosis. Eur J Neurol. 2009;16(11):1202-1209.
- de Graaf WL, Kilsdonk ID, Lopez-Soriano A, et al. Clinical application of multi-contrast 7-T MR imaging in multiple sclerosis: increased lesion detection compared to 3 T confined to grey matter. Eur Radiol. 2013;23(2):528-540.
- Calabrese M, De Stefano N, Atzori M, et al. Detection of cortical inflammatory lesions by double inversion recovery magnetic resonance imaging in patients with multiple sclerosis. Arch Neurol. 2007;64(10):1416-1422.
- Lucchinetti CF, Popescu BF, Bunyan RF, et al. Inflammatory cortical demyelination in early multiple sclerosis. N Engl J Med. 2011;365(23):2188-2197.
- Calabrese M, Agosta F, Rinaldi F, et al. Cortical lesions and atrophy associated with cognitive impairment in relapsing-remitting multiple sclerosis. Arch Neurol. 2009;66(9):1144-1150.
- Rio J, Nos C, Tintoré M, et al. Assessment of different treatment failure criteria in a cohort of relapsing–remitting multiple sclerosis patients treated with interferon β: implications for clinical trials. Ann Neurol. 2002;52(4):400-406.
- Deloire M, Ruet A, Hamel D, Bonnet M, Brochet B. Early cognitive impairment in multiple sclerosis predicts disability outcome several years later. Mult Scler. 2010;16(5):581-587.
- Tremlett H, Yousefi M, Devonshire V, Rieckmann P, Zhao Y; on behalf of the UBC Neurologists. Impact of multiple sclerosis relapses on progression diminishes with time. Neurology. 2009;73(20):1616-1623.