Is it time to rethink our definition of a relapse? #MSBlog #MSResearch
"I gave a talk today at a meeting that is focusing on the commissioning
of MS services in England. I was discussing the future of MS treatments and
made a case for “Saving Brain” with the aim of preventing or reducing end-organ damage in MSers. To do this we need to go beyond the current definition of NEDA
(no evident disease activity) and target the base of the “MS iceberg” and try
and normalise brain atrophy rates and spinal fluid neurofilament levels. I know
that this target may seem unreasonable when some MSers in the country are have
difficulty getting simple walking aids or have difficulty accessing their local
or regional neurological services for an assessment for DMTs. Am I pushing the
bubble too far? Do we have enough evidence that normalising brain atrophy rates makes a difference?"
"One suggestion I made was that we need to challenge the older NICE
guidance on not being able to escalate DMTs on MRI criteria alone. To escalate
from platform, or 1st-line, DMTs you need to have clinical attacks.
However, the new NICE guidance allows alemtuzumab to be prescribed to MSers
with active MS defined either clinically or on MRI. The latest guidelines therefore
recognise that clinical attacks and MRI activity mean the same thing; i.e. that
MS is active. I therefore propose that we stop referring to new T2-lesions, or gadolinium-enhancing
T1-lesions, as MRI activity and call them subclinical, or asymptomatic, relapses.
If we accept this definition it will change the way we classify MS and our approach to its management; for example we can change the meaning of current NICE guidance’s
when they refer to relapses. We would also have to offer PPMSers who have active MRIs DMTs. What do you think?"
Labels: Iceberg, MRI activity, Relapse, Survey