• J. Neurol. Neurosurg. Psychiatr. · Jan 2024

    Assessing treatment response to oral drugs for multiple sclerosis in real-world setting: a MAGNIMS Study.

    • Serena Ruggieri, Luca Prosperini, Sarmad Al-Araji, Pietro Osvaldo Annovazzi, Alvino Bisecco, Olga Ciccarelli, Nicola De Stefano, Massimo Filippi, Vinzenz Fleischer, Nikos Evangelou, Christian Enzinger, Antonio Gallo, Afagh Garjani, Sergiu Groppa, Shalom Haggiag, Michael Khalil, Matteo Lucchini, Massimiliano Mirabella, Xavier Montalban, Carlo Pozzilli, Paolo Preziosa, Jordi Río, Maria A Rocca, Alex Rovira, Maria L Stromillo, Mauro Zaffaroni, Carla Tortorella, Claudio Gasperini, and MAGNIMS Study Group.
    • Department of Neurosciences, San Camillo Forlanini Hospital, Rome, Italy.
    • J. Neurol. Neurosurg. Psychiatr. 2024 Jan 11; 95 (2): 142150142-150.

    BackgroundThe assessment of treatment response is a crucial step for patients with relapsing-remitting multiple sclerosis on disease-modifying therapies (DMTs). We explored whether a scoring system developed within the MAGNIMS (MRI in Multiple Sclerosis) network to evaluate treatment response to injectable drugs can be adopted also to oral DMTs.MethodsA multicentre dataset of 1200 patients who started three oral DMTs (fingolimod, teriflunomide and dimethyl fumarate) was collected within the MAGNIMS network. Disease activity after the first year was classified by the 'MAGNIMS' score based on the combination of relapses (0-≥2) and/or new T2 lesions (<3 or ≥3) on brain MRI. We explored the association of this score with the following 3-year outcomes: (1) confirmed disability worsening (CDW); (2) treatment failure (TFL); (3) relapse count between years 1 and 3. The additional value of contrast-enhancing lesions (CELs) and lesion location was explored.ResultsAt 3 years, 160 patients experienced CDW: 12% of them scored '0' (reference), 18% scored '1' (HR=1.82, 95% CI 1.20 to 2.76, p=0.005) and 37% scored '2' (HR=2.74, 95% CI 1.41 to 5.36, p=0.003) at 1 year. The analysis of other outcomes provided similar findings. Considering the location of new T2 lesions (supratentorial vs infratentorial/spinal cord) and the presence of CELs improved the prediction of CDW and TFL, respectively, in patients with minimal MRI activity alone (one or two new T2 lesions).ConclusionsEarly relapses and substantial MRI activity in the first year of treatment are associated with worse short-term outcomes in patients treated with some of the oral DMTs.© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.

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