Publications & Reports

Silent lesions on MRI imaging - Shifting goal posts for treatment decisions in multiple sclerosis.

Min M, Spelman T, Lugaresi A, Boz C, Spitaleri D, Pucci E, Grand'Maison F, Granella F, Izquierdo G, Butzkueven H, Sanchez-Menoyo JL, Barnett M, Girard M, Trojano M, Grammond P, Duquette P, Sola P, Alroughani R, Hupperts R, Vucic S, Kalincik T, Van Pesch V, Lechner-Scott J
Department of Neurology, John Hunter Hospital, Newcastle, NSW, Australia.


BACKGROUND: The current best practice suggests yearly magnetic resonance imaging (MRI) to monitor treatment response in multiple sclerosis (MS) patients. OBJECTIVE: To evaluate the current practice of clinicians changing MS treatment based on subclinical new MRI lesions alone. METHODS: Using MSBase, an international MS patient registry with MRI data, we analysed the probability of treatment change among patients with clinically silent new MRI lesions. RESULTS: A total of 8311 MRI brain scans of 4232 patients were identified. Around 26.9% (336/1247) MRIs with one new T2 lesion were followed by disease-modifying therapy (DMT) change, increasing to 50.2% (129/257) with six new T2 lesions. DMT change was twice as likely with new T1 contrast enhancing compared to new T2 lesions odds ratio (OR): 2.43, 95% confidence interval (CI): 2.00-2.96 vs OR: 1.26 (95% CI: 1.22-1.29). DMT change with new MRI lesions occurred most frequently with ‘injectable’ DMTs. The probability of switching therapy was greater only after high-efficacy therapies became available in 2007 (after, OR: 1.43, 95% CI: 1.28-1.59 vs before, OR: 0.98, 95% CI: 0.520-1.88). CONCLUSION: MS clinicians rely increasingly on MRI alone in their treatment decisions, utilizing low thresholds (1 new T2 lesion) for optimizing MS therapy. This signals a shift towards no evidence of disease activity (NEDA)-3 since high-efficacy therapies became available.

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  • Journal: Multiple Sclerosis
  • Published: 20/09/2018
  • Volume: 24
  • Issue: 12
  • Pagination: 1569-1577