Highlights of the 29th Congress of the European Committee for Treatment and Research in MS (ECTRIMS), Copenhagen, DK, October 2-5, 2013 – Recent treatment optimization recommendations have emphasized the importance of monitoring both clinical (relapses, EDSS progression) and radiological (T2 or T1 lesions) changes when assessing treatment response (Freedman et al. Can J Neurol Sci 2013;40: 307-323).
MRI measures show less regression to the mean than annualized relapse rate (ARR) and may provide a more reliable indication of treatment response, according to a new meta-analysis (Sturner et al. ECTRIMS 2013; abstract P295). A total of 24 placebo-controlled phase II or III trials in RRMS (n=4401) were analysed for the period 1996-2013. The mean estimated ARR declined from a baseline 1.62 to 0.80 at six months and 0.60 at 24 months. During that same interval, the number of gadolinium-enhancing lesions declined from 1.93 at baseline to 1.54 at six months and 1.60 at 24 months.
Thus, the considerable regression to the mean for relapse rate was not seen for Gd+ lesion number. The authors concluded that the number of Gd+ lesions is the preferred measure for assessing anti-inflammatory effects of therapy after six months.
A separate study examined clinical and radiological measures in predicting treatment non-response in 71 RRMS patients treated with interferon-beta during weeks 48-144 of treatment (Rojas et al. ECTRIMS 2013; abstract P447).
Relapses + disability progression was only modestly predictive of non-response (hazard ratio 4.6). Greater sensitivity was seen when new active lesions was combined with relapses + progression (HR 10.1). However, the best early prediction of treatment non-response was seen when relapses/progression/new active lesions was combined with brain parenchymal fraction (BPF %) volume change (HR 14.4). Thus, evaluating brain atrophy, in addition to other clinical and radiological assessments, is useful to identify treatment non-response in the second and third year of therapy.
Guest Reviewer: Dr. Paul S. Giacomini, Associate Director, MS Clinic, Montreal Neurological Hospital and Institute, Assistant Professor, Department of Neurology and Neurosurgery, McGill University, Montréal, Québec.