Giovannoni Gavin, Tomic Davorka, Bright Jeremy R, Havrdová Eva
Centre for Neuroscience and Trauma, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK/Department of Neurology, Royal London Hospital, Barts Health NHS Trust, London, UK.
Novartis Pharma AG, Basel, Switzerland.
Mult Scler. 2017 Aug;23(9):1179-1187. doi: 10.1177/1352458517703193. Epub 2017 Apr 6.
Using combined endpoints to define no evident disease activity (NEDA) is becoming increasingly common when setting targets for treatment outcomes in multiple sclerosis (MS). Historically, NEDA has taken account of the occurrence of relapses, brain magnetic resonance imaging (MRI) lesions and disability worsening, but this approach places emphasis on inflammatory activity in the brain and mostly overlooks ongoing neurodegenerative damage. Combined assessments of NEDA which take account of changes in brain volume or neuropsychological outcomes such as cognitive function may begin to address this imbalance, and such assessments may also consider blood or spinal-fluid neurofilament levels or patient-reported outcomes and quality of life measures. If a combined NEDA assessment can be validated in prospective studies as indicative of long-term disease remission at the individual patient level, treating to achieve NEDA could become the goal of clinical practice and achieving NEDA may become the "new normal" state of disease control for patients with MS.
在为多发性硬化症（MS）的治疗结果设定目标时，使用综合终点来定义无明显疾病活动（NEDA）正变得越来越普遍。从历史上看，NEDA考虑了复发、脑磁共振成像（MRI）病变和残疾恶化的发生情况，但这种方法侧重于脑部的炎症活动，并且大多忽略了持续的神经退行性损伤。综合考虑脑容量变化或认知功能等神经心理结果的NEDA综合评估可能会开始解决这种不平衡问题，并且这种评估还可能考虑血液或脑脊液中的神经丝水平或患者报告的结果及生活质量指标。如果综合NEDA评估在前瞻性研究中能够得到验证，表明在个体患者层面实现了长期疾病缓解，那么治疗以实现NEDA可能会成为临床实践的目标，并且实现NEDA可能会成为MS患者疾病控制的“新常态”。
