Abstract
Although no evidence of disease activity (NEDA) permits evaluation of response to treatment in the systematic follow-up of patients with multiple sclerosis (MS), its ability to accomplish detection of surreptitious activity of disease is limited, thus being unable to prevent patients from falling into a non-reversible progressive phase of disease. A protocol of evaluation based on the use of validated biomarkers that is conducted at an early stage of disease would permit the capture of abnormal neuroimmunological phenomena and lead towards intervention with modifying therapy before tissue damage has been reached.
Highlights
Immunomodulatory therapies used in the treatment of patients with the clinical isolated syndrome (CIS) of multiple sclerosis (MS) and early relapsing remitting multiple sclerosis (RRMS), as well as the autologous hematopoietic stem cell transplant used in the treatment of the catastrophic form of the disease, have accomplished a reduction in clinical relapses, a halting in progression toward neurological disability and have demonstrated a reduction of disease activity in MRI scans
We propose a more aggressive approach that challenges the current application of no evidence of disease activity (NEDA)
The loss of NEDA status due to changes in expanded disability status scale (EDSS), which is a method of rating impairment in neurological functions excluding cognition, was infrequent in comparison to the determination provided by the clinical relapse and imaging-based biomarkers[1]
Summary
Immunomodulatory therapies used in the treatment of patients with the clinical isolated syndrome (CIS) of multiple sclerosis (MS) and early relapsing remitting multiple sclerosis (RRMS), as well as the autologous hematopoietic stem cell transplant (aHSCT) used in the treatment of the catastrophic form of the disease, have accomplished a reduction in clinical relapses, a halting in progression toward neurological disability and have demonstrated a reduction of disease activity in MRI scans This progress has led to the emergence of the ‘no evidence of disease activity’ (NEDA) composite which evaluates the response to these therapies in clinical studies, but its systematic application and utility in the clinical setting have not been established[1]. Goals and conclusion In the systematic evaluation of the patient with MS, the primary goal should be the monitoring of evidence of disease control with biomarkers in order to:
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