Abstract Details

Title Challenging the "Disease Free Status" Concept in MS. Are We Dealing with the Appropriate Parameters?

Topic MS and Related Diseases

Presentation(s) P01 - (-)

Poster/Presentation
Number 189

Objective

Background BACKGROUND: Absence of clinical and MRI activity are accepted as paradigms of disease free status in MS treated patients. Clinical activity is defined by no relapses and EDSS progression, while MRI activity by no T1W contrast enhancing lesions as well as no new or enlarging T2W lesions. Previous studies have shown that axonal loss progression may occur with lacking clinical and imaging expression, requiring sophysticated MRI techniques. Our study discusses current concept of disease free, proposing that axonal loss be used as a practical tool for defining optimal treatment.

Design/Methods DESIGN/METHODS: We prospectively studied a cohort of 191 consecutive non-selected patients with relapsing-remitting MS diagnosed according to 2001 McDonald criteria, on regular immunomodulatory treatment. They were submitted to serial clinical examinations and conventional MRI evaluation, focus on relapses, EDSS progression and the presence of T1W Gd enhancing or T2W new/enlarging lesions. On conventional MRI sequences, we studied whole brain and callosal atrophy, using brain parenchymal fraction (BPF) and corpus callosum index (CCI), annually comparing results with data from a control group, composed by other neurological non-inflammatory diseases, as well as data from our hystorical series of secondary progressive MS patients.

Results RESULTS: Among these 191 patients, 89 (46.5%) experienced neither relapses nor sustained progression on EDSS, and no evidence of active MRI lesions, after 5-year, fulfilling proposed criteria for free of disease status. Nevertheless, 43/89 (48.3%) showed a progressive reduction on BPF and CCI, comparable with those stratified as suboptimal responders, some of them reaching scores of patients with progressive MS.

Conclusions CONCLUSIONS: Our data demonstrate that axonal loss can be early detected and followed using a practical method on conventional MRI sequences. We suggest this parameter to be included as a requirement for "disease free" patient concept.

Authors/Disclosures
Fernando F. Figueira, MD PRESENTER	No disclosure on file
Gustavo Figueira, MD	No disclosure on file
	No disclosure on file
	No disclosure on file
Krzysztof W. Selmaj (University of Warmia and Mazury)	Krzysztof W. Selmaj has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Biogen. Krzysztof W. Selmaj has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novartis. Krzysztof W. Selmaj has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Roche. Krzysztof W. Selmaj has received personal compensation in the range of $500-$4,999 for serving as a Consultant for BMS. Krzysztof W. Selmaj has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Astra. Krzysztof W. Selmaj has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Merck. Krzysztof W. Selmaj has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for BMS. Krzysztof W. Selmaj has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Astra. Krzysztof W. Selmaj has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Biogen. Krzysztof W. Selmaj has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Roche. Krzysztof W. Selmaj has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Novartis. Krzysztof W. Selmaj has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for BMS. Krzysztof W. Selmaj has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Merck.

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