Rates of worsening secondary progressive multiple sclerosis (SPMS) were substantially lower when compared to earlier natural history studies, according to recent research. Notably, the no evidence of disease activity (NEDA) 2-year endpoint was not a predictor of long-term stability. Researchers conducted a prospective study of 517 actively managed MS patients. More than 91% of patients were retained, with data ascertained up to 10 years after the baseline visit. They found:

• In the last assessment, neurologic disability, as measured by the Expanded Disability Status Score (EDSS), was stable or improved compared to baseline in 41% of patients.

• Subjects with 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.

• At a median time of 16.8 years after disease onset, 10.7% of patients reached an EDSS ≥6 and 18.1% evolved from relapsing MS to SPMS.

The data call into question the use of annual MRI assessments as a treat-to-target approach for MS care.

Citation: Cree B, Gourraud PA, Oksenberg JR, et al. Long-term evolution of multiple sclerosis disability in the treatment era. [Published online ahead of print July 27, 2016]. Ann Neurol. doi:10.1002/ana.24747.