Faculty Collaboration Database

Identification and management of subclinical disease activity in early multiple sclerosis: a review. J Neurol 2024 Apr;271(4):1497-1514

Date

10/21/2023

Pubmed ID

37864717

Pubmed Central ID

PMC10972995

DOI

10.1007/s00415-023-12021-5

Scopus ID

2-s2.0-85174576757 (requires institutional sign-in at Scopus site)   3 Citations

Abstract

IMPORTANCE: Early treatment initiation in multiple sclerosis (MS) is crucial in preventing irreversible neurological damage and disability progression. The current assessment of disease activity relies on relapse rates and magnetic resonance imaging (MRI) lesion activity, but inclusion of other early, often "hidden," indicators of disease activity may describe a more comprehensive picture of MS.

OBSERVATIONS: Early indicators of MS disease activity other than relapses and MRI activity, such as cognitive impairment, brain atrophy, and fatigue, are not typically captured by routine disease monitoring. Furthermore, silent progression (neurological decline not clearly captured by standard methods) may occur undetected by relapse and MRI lesion activity monitoring. Consequently, patients considered to have no disease activity actually may have worsening disease, suggesting a need to revise MS management strategies with respect to timely initiation and escalation of disease-modifying therapy (DMT). Traditionally, first-line MS treatment starts with low- or moderate-efficacy therapies, before escalating to high-efficacy therapies (HETs) after evidence of breakthrough disease activity. However, multiple observational studies have shown that early initiation of HETs can prevent or reduce disability progression. Ongoing randomized clinical trials are comparing escalation and early HET approaches.

CONCLUSIONS AND RELEVANCE: There is an urgent need to reassess how MS disease activity and worsening are measured. A greater awareness of "hidden" indicators, potentially combined with biomarkers to reveal silent disease activity and neurodegeneration underlying MS, would provide a more complete picture of MS and allow for timely therapeutic intervention with HET or switching DMTs to address suboptimal treatment responses.

Author List

Ontaneda D, Chitnis T, Rammohan K, Obeidat AZ

Author

Ahmed Zayed Obeidat MD, PhD Associate Professor in the Neurology department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Cognition
Cognitive Dysfunction
Humans
Magnetic Resonance Imaging
Multiple Sclerosis
Multiple Sclerosis, Relapsing-Remitting
Recurrence