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Symposium at ECTRIMS 2015 –Long-term disability prevention: The ultimate goal

Mark S. Freedman

ECTRIMS_Symposium_03_Mark_S_Freedman

The satellite symposium was sponsored by Merck KGaA, Darmstadt, Germany

According to Professor Freedman, treatment of multiple sclerosis should delay or prevent the accumulation of permanent disability and should be evaluated over a prolonged time frame, with an absolute minimum of 2 years of therapy. It would be ideal if early damage could be prevented, but it is very difficult to study progression in early phases. What is usually measured is the frequency of relapses and the correlate of MRI activity. These are only surrogate parameters.

It has been demonstrated that IFN slows progression in disability (assessed by EDSS) over 2 years. Dimethylfumarate had inconsistent effects on disability outcome, even though MRI and relapses improved. Thus these changes must not always be in parallel.

Professor Freedman concluded that EDSS is an insensitive measure, particularly in the short term (1-2 years). Conventional MRI markers do not correlate with disability. However, the number and volume of cortical lesions correlate with clinical worsening. Other approaches include the estimation of brain atrophy or the number of “black holes” (T1-weighted hypodense lesions) in MRI.

An alternative approach is to identify patients with “no evidence of disease activity” (NEDA), which means no relapse, no progression, no T2 lesions and no Gd lesions. NEDA is achievable with first line IFN therapy. Another possibility is to use the “Rio score”, which is a combination of MRI and relapse data after 1 year of treatment. EDSS is not included. It has been shown that patients with the highest Rio scores are more likely to show progression over time.

Professor Freedman emphasised that more sensitive and robust outcome measures are required to evaluate the effects of treatment on disease progression. Better methods are needed to translate short term treatment response to long-term outcomes. The ultimate goal of MS therapy should remain the prevention of long-term disability progression. 

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