Getting the measure of multiple sclerosis

Abstract

In this issue of The Lancet Neurology, Eva Havrdova and co-workers 1 Havrdova E Galetta S Hutchinson M et al. Effect of natalizumab on clinical and radiological disease activity in multiple sclerosis: a retrospective analysis of the Natalizumab Safety and Efficacy in Relapsing-Remitting Multiple Sclerosis (AFFIRM) study. Lancet Neurol. 2009; (published online Feb 9.)https://doi.org/10.1016/S1474-4422(09)70021-3 Summary Full Text Full Text PDF Scopus (376) Google Scholar provide an interesting approach to the assessment of a treatment for multiple sclerosis by combining clinical and MRI outcomes in a measure of so-called disease freedom. As with other neurological disorders, development of outcome measures for multiple sclerosis that are meaningful to clinicians and patients over both short and long periods is difficult, because no single measure captures the disease complexity. Even the most widely used measure—the expanded disability status scale—is a composite score in some senses, but becomes a measure of ability to walk above a score of 5 on a 0–10 scale. The multiple sclerosis functional composite 2 Rudick RA Cutter G Reingold S The multiple sclerosis functional composite: a new clinical outcome measure for multiple sclerosis trials. Mult Scler. 2002; 8: 359-365 Crossref PubMed Scopus (160) Google Scholar and its successors are designed to measure the various domains of dysfunction but maintain the ability to detect changes between treatment groups. No widely accepted serum or CSF biomarkers of disease activity exist, and relapse rate—despite its potential variability—is the measure of disease activity used in most clinical trials for relapsing-remitting disease. Effect of natalizumab on clinical and radiological disease activity in multiple sclerosis: a retrospective analysis of the Natalizumab Safety and Efficacy in Relapsing-Remitting Multiple Sclerosis (AFFIRM) studyDisease remission might become an increasingly attainable goal in multiple sclerosis treatment with the use of newer, more effective therapies. Full-Text PDF