Neuros lacking ambition?

N. de Stefano, M. L. Stromillo, A. Giorgio, M. L. Bartolozzi, M. Battaglini, M. Baldini, E. Portaccio, M. P. Amato, M. P. Sormani
Long-term assessment of No Evidence of Disease Activity (NEDA) in patients with relapsing-remitting multiple sclerosis

Background/aims : In multiple sclerosis (MS), assessment of the status of “no evidence of disease activity (NEDA)” usually incorporates active MRI lesions, relapses, and disability progression. MRI-derived brain volume loss (BVL) has been recently proposed as an additional component (NEDA-4). Only a few data are available on the persistence of NEDA in the long term in MS patients. 

Methods or Materials or Case Report: We studied a population of 91 RRMS patients (mean age=34 years, mean disease duration=5 years, median Expanded Disability Status Scale (EDSS)=1.5, 71% females). Patients underwent clinical and MRI examinations over 10 years. The 90% of patients were treated with current disease-modifying therapies (DMTs) during the study follow up. NEDA was defined as no new/enlarging T2 lesions on MRI, no relapses and no EDSS progression and was assessed over 10 years. NEDA-4 was also assessed, keeping the annualized value of -0.4% as the cut-off for no evidence of BVL.
Results: After 10 years, there were RRMS patients free from MRI activity (22%), relapses (33%), EDSS progression (55%) and BVL (37%). Patients with NEDA were 8 of 91 (8.8%) and patients with NEDA-4 were 5 of 91 (5.5%).
Conclusion: In a clinical population of RRMS patients, NEDA rarely persists in the long term. NEDA is an interesting outcome for clinical trials, but it might not be a realistic goal in clinical setting with current DMTs.
In the recent post on the UK neurologists guidelines, that there was no real view that NEDA had to be a target. As you said- an opportunity missed.

This study presented at EAN looks at a group of MSers an how NEDA was achieved. No evidence of disease activity was achieved in only 6% of people after ten years. Is this the level of ambition of our neurologists... woeful? 

ProfG gave a talk about kidney transplants an how nephrologists aim to save every bit of kidney tissue. Why should neurologists not similarly care about every bit of brain. You can always get a new kidney but you are not getting a new brain. 

Is it not time that you get your neuros to wake up. The best way to save brain is to get your MS under control as quickly as possible. Wait an see maybe be what risk averse Neuros's your brain 

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