Sunday, 23 August 2015

ResearchSpeak: real-life data in support of NEDA

Can we really ignore the treatment target of NEDA #ResearchSpeak #MSBlog #MSResearch

"In this relatively small study on MSers in Oslo, Norway, it is clear that MSers rendered NEDA (no evident disease activity) at 12 months on a DMT (disease-modifying therapy) do better than those who have EDA (evident disease activity). NEDA MSers had on average and improvement in their disability and less gray matter atrophy compared to MSers with EDA."

"Please note the numbers (n = 72) and the follow-up (12 months) is very short. In addition, this study is not randomised, but open-label and hence there could be other factors that could explain the results. However, this data, and other data, supports the treatment principle of NEDA as a valid therapeutic target in MS. Put another way what would you like to be NEDA or EDA? If you are on a DMT and are not having annual MRI scans to look for subclinical relapses you should ask the question why not?"


Nygaard et al. A Longitudinal Study of Disability, Cognition and Gray Matter Atrophy in Early Multiple SclerosisPatients According to Evidence of Disease Activity. PLoS One. 2015;10:e0135974

Background: New treatment options may make "no evidence of disease activity" (NEDA: no relapses or disability progression and no new/enlarging MRI lesions, as opposed to "evidence of disease activity" (EDA) with at least one of the former), an achievable goal in relapsing-remitting multiple sclerosis(RRMS). 


Objective: The objective of the present study was to determine whether early RRMS patients with EDA at one-year follow-up had different disability, cognition, treatment and gray matter (GM) atrophy rates from NEDA patients and healthy controls (HC). 

Methods: RRMS patients (mean age 34 years, mean disease duration 2.2 years) were examined at baseline and one-year follow-up with neurological (n = 72), neuropsychological (n = 56) and structural MRI (n = 57) examinations. Matched HC (n = 61) were retested after three years. 

Results: EDA was found in 46% of RRMS patients at follow-up. EDA patients used more first line and less second line disease modifying treatment than NEDA (p = 0.004). While the patients groups had similar disability levels at baseline, they differed in disability at follow-up (p = 0.010); EDA patients progressed (EDSS: 1.8-2.2, p = 0.010), while NEDA patients improved (EDSS: 2.0-1.7, p<0.001). Cognitive function was stable in both patient groups. Subcortical GM atrophy rates were higher in EDA patients than HC (p<0.001). 

Conclusions: These results support the relevance of NEDA as outcome in RRMS and indicate that pathological neurodegeneration in RRMS mainly occur in patients with evidence of disease activity.

3 comments:

  1. I think we all want to be EM'ers NEDA ... Here in Brazil, at least in my city, the neurologist prescribed 01 annual MRI if you have not had outbreaks, new or old symptoms exacerbated and if NEDA. For cases EDA if they prescribe 02 annual MRI and in case of an outbreak, depending on the severity of this, come to perform MRI to check for are new or old injuries at work ... It's easier to follow here this protocol when the patient has plan health, depending on the city for the MRI machines made available by SUS to states and municipalities are crammed with people waiting for the opportunity to take the examination. In other cities with lower population index, is achieved by making the MRI SUS even, until very fast. In other smaller towns sometimes the City does not use the amount allocated by the SUS for equipment of hospitals, so sometimes patients have to travel to the nearest town to get the MRI ... I for now I am NEDA, EDSS 1.0, treatment with Copaxone and vitamin D3 basically my health plan is serving to hold the annual MRI and additional tests because the medication I take the SUS in the State Pharmacy high cost. But sometimes I find myself wondering whether it would be better to be in a much more effective DMT, as Fingolimode, Natalizumab or Rituximab ...

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  2. Lemtrada can be practically a cure in your situation as far as I can translate all the data available:) thank God for lemtrada

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    1. Ah yes, I even venture to use Lemtrada, the problem is that here in Brazil, most neurologists, and the very SUS guidelines for treatment of MS still find it best to deal with cases of CISers or EM milder with DMT's first line (here are the interferons and Copaxone) ... Find here a neuro who has a more "open and effective" will be hard work ...

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