POOR PROGNOSIS MAY REQUIRE DECISIVE ACTION

  • MS is the leading cause of nontraumatic young-adult neurologic disability1
  • Cumulative effects of disease activity incurred early in the disease course may lead to progressive disease and long-term neurologic damage2-4

Prompt decision making early in the course of relapsing MS and throughout treatment may affect patient outcomes2,5-7

THERE IS A STRONG CORRELATION BETWEEN MRI LESION LOAD AND THE SEVERITY OF PHYSICAL DISABILITY AT 5 YEARS8

Adapted from Comi, Clin Ther, 2009; Compston, Lancet, 2008; Fisniku, Brain, 2008; and Trapp, Neuroscientist, 1999.2,9-11
For illustrative purposes only.

There may be a therapeutic window of opportunity in optimizing treatment3,4,12,13

  • The volume and the accumulation of T2 lesions over 2 years were significantly correlated with future physical disability14
  • Brain lesions at baseline were predictive of physical disability status after 10 years15

MRI can help detect subclinical disease2,16,17

  • After 1 year of treatment16,17:
    • Relapse-free patients continued to show active disease on MRI and significant risk of worsening physical function
    • Risk of disease progression has been shown to rise as lesion load and relapse rate increase

Consider monitoring for an inadequate response after the first 6 to 12 months of therapy. An inadequate response can be defined by a combination of parameters, which may include17-19:

MRI
Activity
  • Ongoing disease activity detected by MRI17,20
  • ≥1 Gd+ lesion or new or enlarging T2-hyperintense lesion within 1 year17,18
Level of Physical
Disability
  • An increase in EDSS score on new therapy4,18
  • ≥1-point EDSS score increase at
    6 months21
Relapse
Frequency
  • Recurring relapse after treatment initiation17,20
  • ≥1 relapse within 1 year 4,17

Proportion of patients on first-line therapies with an inadequate response can vary based on criteria used. Some studies prior to 2010 show that up to two-thirds of patients may exhibit an inadequate response after relapsing MS treatment initiation.4,18,22

REAL EXPERIENCES TREATING RMS

Leading physicians discuss the need to monitor disease activity to help guide treatment decisions.

CSF=cerebrospinal fluid; IgG=immunoglobulin G; IgM=immunoglobulin M; DMT=disease-modifying therapy; ARR=annualized relapse rate; EDSS=Expanded Disability Status Scale.