Initial Cleveland Clinic disease-activity free meeting update

I am sitting in the airport lounge in Chicago; frustrated as my flight is delayed. Apparently the pilot's seat has malfunctioned and needs to be replaced; a first for me!

As requested I have uploaded my slides for you to look at. When I get a moment I will upload an actual lecture to YouTube. The meeting went well and the preliminary results of the disease-activity free (DAF) survey were very helpful to illustrate the point that concept of disease-activity free (DAF) status has yet to diffuse into clinical practice. 

The headline take home message from the meeting is that we should probably stick with the current trial definition of DAF, i.e. relapse, disease progression and MRI-activity free with the aim of including other markers of disease activity as they emerge, for example MSer-related outcomes and other MRI metrics. What is clear is that the current definition of DAF would not work for progressive MS; by definition progressive MS is progressing. Another issue that was discussed is when do we need to do a baseline MRI to compare MRIs with in the future? If a DMT has a delayed onset of action you would need to do a baseline scan after the drug starts working for use for future comparisons. In the case of glatiramer acetate this would need to be sometime after 6 months. Another problem that was discussed is the difference between maintenance and induction therapies in relation to DAF. Disease activity on maintenance DMTs, e.g. IFNbeta and GA, is an indication of a sub-optimal response. In comparison, disease activity post induction therapies, for example Alemtuzumab and Cladribine, does not necessarily mean non-response but rather the need to re-treat. The good news is that the meeting will result in a consensus working statement, which will be very important initial step to move the field forward and hopefully to get neurologists to aim on getting MSers with relapsing MS DAF. 

The problem we have in the UK is that our current guidelines to not accept MRI activity as a treatment failure. What can we do about it? That is a story for another day. 

Disease-activity free status talk - Cleveland Clinic 20 Sept 2012 from gavingiovannoni

Again, thank you for responding so quickly to the DAF survey! I hope the slides speak for themselves. 

20 Sep 2012
I am about to travel to the Cleveland Clinic, in Ohio, to attend a meeting on "Freedom from MS Disease Activity"; a subject that is very close to my heart. This concept is well advanced in the fields of oncology, rheumatology and ...

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