Can a physician predict the clinical response to a DMT?

EpubMezei et al. Can a physician predict the clinical response to first-line immunomodulatory treatment in relapsing-remitting multiple sclerosis? Neuropsychiatr Dis Treat. 2012;8:465-73. doi: 10.2147/NDT.S36771. Epub 2012 Oct 23.

BACKGROUND: Decreased relapse rate and slower disease progression have been reported with long-term use of immunomodulatory or disease-modifying treatments (DMTs, interferon beta or glatiramer acetate) in RRMS. There are, however, MSers who do not respond to such treatments, and they can be potential candidates for alternative therapeutic approaches.

OBJECTIVE: To identify clinical factors as possible predictors of poor long-term response.

METHODS: A 9-year prospective, continuous follow-up at a single center in Hungary to assess clinical efficacy of DMTs.

RESULTS: In a MSer group of 81 subjects with mean DMT duration of 54 ± 33 months, treatment efficacy expressed as annual relapse rate and change in clinical severity from baseline did not depend on the specific DMT (any of the interferon betas or glatiramer acetate), and on mono- or multifocal features of the initial appearance of the disease. Responders had shorter disease duration and milder clinical signs at the initiation of treatment. Relapse-rate reduction in the initial 2 years of treatment predicted clinical efficacy in subsequent years.


CONCLUSION: Based on these observations, we suggest that a 2-year trial period is sufficient to decide on the efficacy of a specific DMT. For those with insufficient relapse reduction in the first 2 years of treatment, a different DMT or other therapeutic approaches should be recommended.


"I couldn't agree more and would go further and suggest incorporating MRI monitoring and NAB testing into the algorithm. The data is now clear that if you have MRI evidence of disease-activity (new or enlarging T2 and/or Gd-enhancing lesions) you are more likely to fail in the next 2 to 5 years (relapses and/or disease progression). This is why I have been pushing the concept of disease-activity free status on this blog in the past few months. The new concept is treat-to-target; i.e. treat to render MSers disease-activity free. This is a concept we have adopted from our rheumatology colleagues who do this with rheumatoid arthritis; since rheumatologists have become aggressive treaters the number of joint replacements have plummeted. At least with joints you can replace them; unfortunately the same cannot be said for the brain and spinal cord."

Other related posts on this blog:

20 Sep 2012
I would therefore appreciate it if you could help by completing the following survey, which will take less than a minute, to see if if you have been exposed to the "disease-activity free " concept in clinic. Please note that all ...
01 Oct 2012
"In response to a comment about incorporating disease-activity free status into routine clinical practice in the UK I have made this short talk that tries to explain the current problems we are having in the UK. It should be ...
23 Sep 2012
The meeting went well and the preliminary results of the disease-activity free (DAF) survey were very helpful to illustrate the point that concept of disease-activity free (DAF) status has yet to diffuse into clinical practice.
29 Sep 2012
why would any doctor not want their patients to free of disease activity? Surely you start patients on a first line thrapy and them monitor them e.g. MRI, clinical examination. If their is disease activity e.g. MRI shos inflammation, ...

23 Sep 2012
The meeting went well and the preliminary results of the disease-activity free (DAF) survey were very helpful to illustrate the point that concept of disease-activity free (DAF) status has yet to diffuse into clinical practice.

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