Assessing ‘no evidence of disease activity’ status in patients with relapsing–remitting MS: a long-term follow-up, 2023, Chiara Zilli et al

Introduction: Multiple Sclerosis (MS) is a chronic inflammatory demyelinating disease of the CNS with an autoimmune pathogenesis. Over the years, numerous disease-modifying therapies (DMTs) have proven effective in disease control; to date, there is a need to identify a personalized treatment effective in ensuring disease-free status or no evidence of disease activity (NEDA).

Objective: identify clinical, demographic and treatment approach characteristics that affect the maintenance of NEDA-3 and the occurrence of clinical relapses during a 6-years follow-up.

Materials and method: a retrospective study was conducted on a cohort of MS patients followed up with six-year period. All participants were treated with first- or second-line MS drugs.

Clinical relapse, NEDA-3 at 6 years and sustained EDSS were assessed as disease activity outcomes. Patients with follow-up of less than 6 years and insufficient clinical and radiological data were excluded from the study.

Results: Two-hundred-eighty naive patients (mean age was 49.8 years, SD ± 11.35 years, 23–76, F/M 182/98), with MS were followed up for 6 years.

The mean age at diagnosis was 34.3 years (SD ±11.5, 14–62 years), the mean EDSS score at the onset was 1.9 (±1.3), 76.8% of patients had an EDSS below or equal to 2.5 at diagnosis.

In the cohort 37 (13.2%) directly received second-line treatment, 243 (86.8%) received first-line drugs.

The analysis showed that second-line treatment from beginning had a protective effect for the achievement of NEDA-3 (p = 0.029), on the prevention of clinical relapse (p = 0.018) and on number of relapses (p = 0.010); this finding was confirmed by logistic regression analysis (p = 0.04) and Kaplan–Meier analysis (p = 0.034).

Conclusion: The results of this study demonstrate the efficacy of targeted and early intervention so as to act in the right time window, ensuring a favorable outcome in both clinical and radiological terms; this could be decisive in reducing clinical relapse, disease progression and related disability. Therefore, prescribing highly effective drug in the early stages of the disease represents a leading strategy with the most favorable cost–benefit ratio.

https://www.frontiersin.org/articles/10.3389/fneur.2023.1187851/full

 

I can't help but wonder if Sherlock is still in the bathroom.....

Treating sick patients with highly effective drugs helps them, and therefore may be cheaper than doing other things, including not treating them.

Whatever wacky idea works I suppose.

 

And with the FND trend, neurology is heading hard in the opposite direction. Test as little as possible, in fact if possible, don't even test. Wait for symptoms, dismiss them as much as possible.

Who knew that being smart about things was, uh, smart?