One-year MRI scan predicts clinical response to interferon beta in multiple sclerosis

Authors

  • L. Prosperini,

    1. Multiple Sclerosis Centre, Department of Neurological Sciences, S. Andrea Hospital, “La Sapienza” University, Rome, Italy
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  • V. Gallo,

    1. Multiple Sclerosis Centre, Department of Neurological Sciences, S. Andrea Hospital, “La Sapienza” University, Rome, Italy
    2. Division of Epidemiology, Public Health and Primary Care and Division of Neuroscience and Mental Health, Imperial College London, London, UK
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  • N. Petsas,

    1. Neurological Centre of Latium, Rome, Italy
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  • G. Borriello,

    1. Multiple Sclerosis Centre, Department of Neurological Sciences, S. Andrea Hospital, “La Sapienza” University, Rome, Italy
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  • C. Pozzilli

    1. Multiple Sclerosis Centre, Department of Neurological Sciences, S. Andrea Hospital, “La Sapienza” University, Rome, Italy
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Carlo Pozzilli, MD, PhD, Multiple Sclerosis Centre, S. Andrea Hospital, Department of Neurological Sciences, “La Sapienza” University, Via di Grottarossa, 1035 - 00189, Rome,
Italy (tel.: +39 06 33775686; fax: +39 06 33775900; e-mail: carlo.pozzilli@uniroma1.it).

Abstract

Background and purpose:  To define the predictive value of clinical and magnetic resonance imaging (MRI) characteristics in identifying relapsing-remitting multiple sclerosis (RR-MS) patients with sustained disability progression during interferon beta (IFNB) treatment.

Methods:  All patients receiving treatment with one of the available IFNB formulations for at least 1 year were included in this single-centre, prospective and post-marketing study. Demographic, clinical and MRI data were collected at IFNB start and at 1 year of therapy; patients were followed-up at least yearly. Poor clinical response was defined as the occurrence of a sustained disability progression of ≥1 point in the Expanded Disability Status Scale (EDSS) during the follow-up period.

Results:  Out of 454 RR-MS patients starting IFNB therapy, data coming from 394 patients with a mean follow-up of 4.8 (2.4) years were analysed. Sixty patients were excluded because of too short follow-up. Less than 1/3 (30.4%) of the patients satisfied the criterion of ‘poor responders’. Patients presenting new lesions on T2-weighted MRI scan after 1 year of therapy (compared with baseline) had a higher risk of being poor responder to treatment with IFNB during the follow-up period (HR 16.8, 95% CI 7.6–37.1, P < 0.001). An augmented risk increasing the number of lesions was observed, with a 10-fold increase for each new lesion.

Conclusions:  Developing new T2-hyperintense lesions during IFNB treatment was the best predictor of long-term poor response to therapy. MRI scans performed after 1 year of IFNB treatment may be useful in contributing to early identification of poor responders.

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