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

• Published in: European journal of neurology Vol. 16; no. 11; pp. 1202 - 1209
• Main Authors: Prosperini, L., Gallo, V., Petsas, N., Borriello, G., Pozzilli, C.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.11.2009
• Subjects: Adolescent; Adult; Age of Onset; Child; Disease Progression; Female; Follow-Up Studies; Humans; interferon beta; Interferon-beta - therapeutic use; Longitudinal Studies; magnetic resonance imaging; Magnetic Resonance Imaging - methods; Male; Middle Aged; multiple sclerosis; Multiple Sclerosis, Relapsing-Remitting - drug therapy; Predictive Value of Tests; response to therapy; Risk Factors; Severity of Illness Index; Time Factors; Treatment Outcome
• ISSN: 1351-5101; 1468-1331
• DOI: 10.1111/j.1468-1331.2009.02708.x

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.