Long-Term Multiple Sclerosis Progress Can Be Better Determined Using NEDA Standard

A study published on December 22 in JAMA Neurology emphasizes that a standard measurement used to gauge multiple sclerosis (MS) symptoms, known as “no-evidence-of-disease-activity” (NEDA) is important for determining how the disease will progress long-term.

MS is the most common degenerative neurological condition that affects young adults worldwide. MS can occur at any age, although are generally diagnosis occurs between the ages of 20 and 40.

NEDA is one way to assess MS progression, and refers to a combination of measurements, including an absence of: 1) relapses, 2) increased disability lasting more than three months and 3) magnetic resonance imaging (MRI) evidence of MS.

The study authors underscored that NEDA should be a new MS treatment goal and outcome measure “because of multiple and increasingly effective therapies for relapsing forms of the neurodegenerative disabling disease.” However, they cautioned that the actual occurrence of NEDA is unclear, stating “it’s unknown what proportion of patients with MS can be expected to maintain NEDA over time.” The present study sought to clarify and measure NEDA occurrence.

Dalia L. Rotstein, M.D., of Brigham and Women’s Hospital, Boston, and her co-workers measured NEDA for seven years in 219 patients with MS. The researchers performed yearly brain MRI and clinic visits twice a year, although sometimes patients missed a few of these assessments. NEDA was measured as defined by the standard, using a count of the number of relapses, measurement of disability progression and MRIs.

The researchers reported that 215 patients, 99 (46 percent) had NEDA at one year, while at two years 60 of 218 patients (27.5 percent) maintained NEDA. However, disappointingly only 7 of 216 patients (7.9 percent) had NEDA following the complete seven year course of the study.

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The authors of the study also looked at NEDA in people with different types of MS, finding no difference in NEDA in patients with early MS (five years or less since first MS symptom) versus patients with more long-term disease.

Overall, NEDA after two years appeared to be the most effective point for predicting later MS-related disability at seven years. Future research is needed to confirm this finding, however.

The researchers concluded that, “Although NEDA has the potential to become not only a key outcome measure of disease-modifying therapy but also a treat-to-target goal, it will require a comprehensive approach that integrates advances in MRI technology, linkage of blood and cerebrospinal fluid biomarkers, and a high degree of cooperation among investigators.”

NEDA may ultimately play a part of a comprehensive package of measurements used by neurologists to assess MS prediction and the response of MS symptoms to treatments, both present and future.