Is it time to target no evident disease activity (NEDA) in multiple sclerosis?

The management of multiple sclerosis is becoming increasingly complex with the emergence of new and more effective disease-modifying therapies (DMT). We propose a new treatment paradigm that individualises treatment based on a choice between two interchangeable therapeutic strategies of maintenance-...

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Vydané v:Multiple sclerosis and related disorders Ročník 4; číslo 4; s. 329 - 333
Hlavní autori: Giovannoni, Gavin, Turner, Benjamin, Gnanapavan, Sharmilee, Offiah, Curtis, Schmierer, Klaus, Marta, Monica
Médium: Journal Article
Jazyk:English
Vydavateľské údaje: Netherlands Elsevier B.V 01.07.2015
Predmet:
Algorithms
Disease activity free
Disease modifying therapy
Disease Progression
Humans
Magnetic Resonance Imaging
Multiple sclerosis
Multiple Sclerosis - pathology
Multiple Sclerosis - physiopathology
Multiple Sclerosis - therapy
NEDA
Neurology
No evident disease activity
Precision Medicine - methods
Treating to target
Treatment Outcome
NEDA
Disease modifying therapy
Multiple sclerosis
Disease activity free
No evident disease activity
Treating to target
ISSN:2211-0348, 2211-0356, 2211-0356
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Shrnutí:The management of multiple sclerosis is becoming increasingly complex with the emergence of new and more effective disease-modifying therapies (DMT). We propose a new treatment paradigm that individualises treatment based on a choice between two interchangeable therapeutic strategies of maintenance-escalation or induction therapy. We propose treating- to-target of no evident disease activity (NEDA) as defined using clinical and MRI criteria. This algorithm requires active monitoring with a rebaselining MRI, at a point in time after the specific DMT concerned has had sufficient time to work, and at least annual MRI studies to monitor for subclinical relapses. Disease activity on the maintenance-escalation therapy arm of the algorithm indicates a sub-optimal treatment response and should trigger a discussion about switching, or escalating, therapy or the consideration of switching to the induction therapy arm of the algorithm. In comparison, disease activity on an induction therapy arm would be an indication for retreatment or a switch to the maintenance-escalation therapy arm. We envisage the definition of NEDA evolving with time as new technological innovations are adopted into clinical practice, for example the normalisation of whole, or regional, brain atrophy rates and cerebrospinal fluid neurofilament levels
Bibliografia:ObjectType-Article-1
SourceType-Scholarly Journals-1
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ObjectType-Review-3
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ISSN:2211-0348
2211-0356
2211-0356
DOI:10.1016/j.msard.2015.04.006