(Innsbruck, Vienna, Bern, 10-09-2024) The results of a multicentre study on multiple sclerosis recently published in the journal "Neurology" could significantly improve the treatment of this chronic inflammatory disease. Researchers from the Medical Universities of Innsbruck and Vienna and the Inselspital, University Hospital Bern have shown that two or more lesions in the brain visible on magnetic resonance imaging (MRI) within one year are an indication in favour of intensifying treatment. This is the first time that clear and evidence-based criteria for therapy adjustment have been established.
For the neurological disease multiple sclerosis* (MS), a number of treatment options have been available for several years that can favourably influence the extent of the inflammatory reaction and the associated patient symptoms, even in severe cases. In this way, the development of so-called relapses and permanent disability can be contained.
In addition to clinical symptoms, which cover a broad spectrum from visual impairment to signs of paralysis, disease activity in MS can also be visualised using imaging. "The detection of inflammatory lesions in the brain using MRI also allows an assessment of lower disease activity, as supposedly stable patients can continue to develop new, clinically silent, inflammatory changes despite therapy," says neuroimmunologist Harald Hegen, who has been researching MS at the Innsbruck University Department of Neurology for many years.
Whether MS therapy should be adapted on the basis of MRI diagnostics alone or how many lesions are decisive in the MRI has now been clarified for the first time as part of a retrospective study under the joint leadership of the neurological university clinics in Innsbruck, Vienna and Bern. "Neurology", the medical journal of the American Academy of Neurology, reports on the far-reaching findings.
The study cohort included 131 MS patients at MS centres in Austria and Switzerland who were clinically stable for twelve months under low to moderate effective immunotherapy and then underwent MRI. "We were able to show that patients with relapsing-remitting MS who develop two or more new inflammatory MRI lesions within one year of immunotherapy benefit from switching to a highly effective immunotherapy even if they are clinically stable, i.e. without symptoms," says first author Gabriel Bsteh from the Medical University of Vienna, describing the key finding. The study thus provides an important finding for everyday clinical practice, which should be used for individualised therapy adaptation.
"Since lesions are often visible on MRI even before clinical symptoms appear, imaging monitoring in patients with low to moderately effective therapy enables early intervention in the individual course of the disease," emphasises study co-leader Harald Hegen. In the study cohort, around 40 per cent of patients were clinically stable but already showed one or more lesions on MRI. Up to now, in clinical practice, therapy adaption was only indicated after the appearance of clinically manifest symptoms.
The multicentre study, whose results are to be incorporated into future recommendations for therapy guidelines, is a flagship project of a cooperation between MS centres in Austria and Switzerland that has been continuously developed over the last few years. "Together, we have a comprehensive database of more than 8,000 MS patients. Such multi-centre collaborations provide the necessary basis in terms of case numbers and data quality for a large number of other projects to improve the care of MS patients," concludes consortium co-leader Gabriel Bsteh.
*Multiple sclerosis, a chronic inflammatory disease of the central nervous system, is the most common neurological disease that leads to permanent disability in young adulthood. It causes inflammatory changes in the central nervous system (brain and spinal cord). Paralyses, sensory deficits, balance disorders, visual disturbances, walking difficulties and cognitive impairments can be the result.
Publication: Neurology
Association of Disease-Modifying Treatment With Outcome in Patients With Relapsing Multiple Sclerosis and Isolated MRI Activity.
Gabriel Bsteh, Marie L. Aicher, Janette F. Walde, Nik Krajnc, Lukas Haider, Gerhard Traxler, Christiane Gradl, Anke Salmen, Katharina Riedl, Paulina Poskaite, Philipp Leyendecker, Patrick Altmann, Michael Auer, Klaus Berek, Franziska Di Pauli, Barbara Kornek, Fritz Leutmezer, Paulus S. Rommer, Gudrun Zulehner, Tobias Zrzavy, Florian Deisenhammer, Andrew Chan, Thomas Berger, Robert Hoepner, Helly Hammer and Harald Hegen.
https://www.neurology.org/doi/10.1212/WNL.0000000000209752