5th Joint triennial congress of the European and Americas Committees
for Treatment and Research in Multiple Sclerosis
Amsterdam, The Netherlands

19.10.2011 - 22.10.2011
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Home - 20.10.2011 - How to decide whether a patient responds to treatment


How to decide whether a patient responds to treatment

Thursday, October 20, 2011, 11:10 - 11:25

Brain MRI activity after disease-modifying treatment may predict disability progression after 5 years in relapsing-remitting multiple sclerosis patients

M. Romeo, V. Martinelli, E. Perego, M. Rodegher, L. Moiola, F. Sangalli, M.P. Sormani, G. Comi (Milan, Genoa, IT)

Objectives: The early identification of multiple sclerosis (MS) patients who will not benefit of a first-line immunomodulatory treatment has a great relevance in clinical practice. Many attempts have been made to identify reliable predictive factors of response to disease-modifying treatments (DMT), but so far none has been validated by a long-term follow-up. The aim of the present study is to define the value of early brain MRI as a possible predictor of long-term clinical disability progression.
Methods: This is an observational single-center study carried out on a large cohort of relapsing-remitting multiple sclerosis (RR-MS) patients treated with DMT at the MS Center of the San Raffaele Institute, in Milan between 1996 and 2005. All patients were treated with one of the different types of beta-interferon (IFNß) or with Glatiramer Acetate (GA) for at least 5 years. The patients were evaluated every 3 months, while brain MRI was performed 6-12 months after starting the DMT, and afterward every 1-2 years in most patients. We have defined as “non-responder” the patients with an EDSS confirmed progression of >= 1.5 point at 5 year follow-up. The patients without a clinical relapse and disability progression <1.5 have been considered as “responder”. Finally “partial responders” were defined the patients without any significant EDSS worsening (EDSS changes lower than 1.5 point), who had at least one relapse.
Results: Six hundred sixty-eight patients of a total of 864 patients completed 5 year follow-up. Brain MRI was performed 6-12 months after starting DMT in 396 patients. 61 patients (15.4 %) presented 3 or more “active” lesions (new T2 or T1 Gd+) at brain MRI scan, when compared with baseline MRI. The presence of more than two “active” lesions was associated with a higher risk of disability progression after 5 year follow-up (Odds Ratio non-responder vs responder 4.0; 95% CI 1.6-10, p= 0.003). The risk increases 2.6 times comparing partial and non-responders vs responders (p= 0.006).
Conclusions: Brain MRI performed 6-12 months after starting DMT may be a useful and sensitive tool in predicting the response to treatment and for the early identification of patients who will develop long-term disability progression. An alternative treatment should be early considered in patients with “active” MRI, before the occurrence of irreversible neurological disability.

Prof Giancarlo Comi has received personal compensation for speaking and consultancy activities from Bayer Schering, Serono Symposia International Foundation, Merck Serono International, Sanofi-Aventis, Biogen Dompè, Novartis and TEVA Pharmaceutical Ind. Ltd. Dr. Vittorio Martinelli has received speaker honoraria or funding for travels from Biogen-Dompé SG, Merck Serono, Bayer Schering Pharma, Novartis and Sanofi-aventis. Dr. Romeo Marzia, Dr. Elisabetta Perego, Dr. Mariaemma Rodegher, Dr.Lucia Moiola, Dr. Francesca Sangalli and Dr. Maria Pia Sormani have nothing to disclose.