https://www.msif.

org/news/2016/09/12/long-term-evolution-of-ms-disability-in-the-treatmentera/

Long-term
evolution of MS
disability in the
treatment era
MRI is not a predictor of long term MS outcomes
Last updated: 12th September 2016

Studies that look at the evolution of MS over many years are called natural
history studies. Previous natural history studies were performed before the
availability of disease modifying drugs (such as interferon, fingolimod, etc.).
In this study, from the San Francisco MS Centre in California, researchers
studied 507 people who they had originally recruited in 2004 and followed for
more than a decade.
Researchers reported that, in this group, only 11% of people with relapsingonset MS had developed progressive disability later in the course of the
disease when assessed 12 years later. Using predictions based on previous
studies, before disease modifying drugs were available, they were expecting
to see 36-50% conversion to progressive MS.
The researchers found that MRI markers of active disease, such as enhancing
lesions, did not predict a more severe disease later. They also found that they

could not use short-term disease progression (such as increase in

neurological examination scored by EDSS) to predict longer-term progression.
This study suggests that short-term progression of MS does not necessarily
mean more severe disease after a decade, when compared to people who
have a less severe progression at the beginning of their disease.
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http://www.ncbi.nlm.nih.gov/pubmed/27464262

Long-term evolution of multiple sclerosis disability in the treatment era.

University of California, San Francisco MS-EPIC Team:, Cree BA1, Gourraud PA2, Oksenberg
JR2, Bevan C2, Crabtree-Hartman E2, Gelfand JM2, Goodin DS2, Graves J2, Green AJ2, Mowry
E2, Okuda DT3, Pelletier D4, von Bdingen HC2, Zamvil SS2, Agrawal A2, Caillier S2, Ciocca
C2, Gomez R2, Kanner R2,Lincoln R2, Lizee A2, Qualley P2, Santaniello A2, Suleiman L2, Bucci
M2, Panara V2, Papinutto N2, Stern WA2, Zhu AH2, Cutter GR5, Baranzini S2, Henry RG2, Hauser
SL2.

Author information
Abstract
OBJECTIVE:
To characterize the accrual of long-term disability in a cohort of actively treated multiple
sclerosis (MS) patients and to assess whether clinical and magnetic resonance imaging
(MRI) data used in clinical trials have long-term prognostic value.
METHODS:
This is a prospective study of 517 actively managed MS patients enrolled at a single center.

RESULTS:
More than 91% of patients were retained, with data ascertained up to 10 years after the
baseline visit. At this last assessment, neurologic disability as measured by the Expanded
Disability Status Scale (EDSS) was stable or improved compared to baseline in 41% of
patients. Subjects with no evidence of disease activity (NEDA) by clinical and MRI criteria
during the first 2 years had long-term outcomes that were no different from those of the
cohort as a whole. 25-OH vitamin D serum levels were inversely associated with short-term
MS disease activity; however, these levels had no association with long-term disability. At a
median time of 16.8 years after disease onset, 10.7% (95% confidence interval [CI] = 7.214%) of patients reached an EDSS6, and 18.1% (95% CI = 13.5-22.5%) evolved from
relapsing MS to secondary progressive MS (SPMS).
INTERPRETATION:
Rates of worsening and evolution to SPMS were substantially lower when compared to
earlier natural history studies. Notably, the NEDA 2-year endpoint was not a predictor of
long-term stability. Finally, the data call into question the utility of annual MRI assessments
as a treat-to-target approach for MS care. Ann Neurol 2016.
2016 The Authors Annals of Neurology published by Wiley Periodicals, Inc. on behalf of
American Neurological Association.