From the Department of Neurosciences (C.G., L.P.), San Camillo-Forlanini Hospital, Rome, Italy; Centre d'Esclerosi Multiple de Catalunya (Cemcat), Department of Neurology/Neuroimmunology (M.T., J.R., J.S.-G., X.M.), and Magnetic Resonance Unit, Department of Radiology (A.R.), Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, Spain; Biostatistics Unit (M.P.S.), Department of Health Sciences, University of Genoa; Neuroimaging Research Unit (M.F., M.A.R.), Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy; Nuffield Department of Clinical Neurosciences (J.P.), West Wing, John Radcliffe Hospital, Oxford; Institutes of Neurology & Healthcare Engineering (O.C., F.B.), University College London (O.C.), UK; Amsterdam Neuroscience and Department of Radiology and Nuclear Medicine (F.B., H.V.), VU University Medical Center, Amsterdam, the Netherlands; Department of Neurology (J.L.F.), Rigshospitalet Glostrup and University of Copenhagen, Denmark; Neuroradiological Academic Unit (T.A.Y.), Institute of Neurology, London, UK; Department of Neurology (C.E.), Medical University of Graz, Austria; Neurologic Clinic and Policlinic, Department of Medicine (L.K.), Clinical Research, Biomedicine and Biomedical Engineering, University Hospital Basel, University of Basel, Switzerland; Department of Neurology and Psychiatry (C.P.), Sapienza University, Rome; and Neurology and Neurometabolic Unit, Department of Neurological and Behavioral Sciences (N.D.S.), University of Siena, Italy.
Neurology. 2019 Jan 22;92(4):180-192. doi: 10.1212/WNL.0000000000006810. Epub 2018 Dec 26.
Over the last few decades, the improved diagnostic criteria, the wide use of MRI, and the growing availability of effective pharmacologic treatments have led to substantial advances in the management of multiple sclerosis (MS). The importance of early diagnosis and treatment is now well-established, but there is still no consensus on how to define and monitor response to MS treatments. In particular, the clinical relevance of the detection of minimal MRI activity is controversial and recommendations on how to define and monitor treatment response are warranted. An expert panel of the Magnetic Resonance Imaging in MS Study Group analyzed and discussed published studies on treatment response in MS. The evolving concept of no evidence of disease activity and its effect on predicting long-term prognosis was examined, including the option of defining a more realistic target for daily clinical practice: minimal evidence of disease activity. Advantages and disadvantages associated with the use of MRI activity alone and quantitative scoring systems combining on-treatment clinical relapses and MRI active lesions to detect treatment response in the real-world setting were also discussed. While most published studies on this topic involved patients treated with interferon-β, special attention was given to more recent studies providing evidence based on treatment with other and more efficacious oral and injectable drugs. Finally, the panel identified future directions to pursue in this research field.
在过去几十年中，改进的诊断标准、MRI 的广泛应用以及越来越多有效的药物治疗方法的出现，使得多发性硬化症（MS）的治疗取得了实质性的进展。早期诊断和治疗的重要性现在已经得到了充分的证明，但对于如何定义和监测 MS 治疗的反应仍然没有共识。特别是，MRI 活动微量检测的临床相关性存在争议，因此有必要就如何定义和监测治疗反应提出建议。MS 磁共振成像研究组的一个专家小组分析和讨论了已发表的关于 MS 治疗反应的研究。研究检查了疾病活动无证据这一不断发展的概念及其对预测长期预后的影响，包括为日常临床实践定义更现实的目标的选择：微量疾病活动证据。还讨论了仅使用 MRI 活动和结合治疗期间临床复发和 MRI 活动性病变的定量评分系统来检测现实环境中治疗反应的优缺点。虽然关于这一主题的大多数已发表研究都涉及接受干扰素-β治疗的患者，但特别关注了基于其他更有效口服和注射药物治疗的最新研究证据。最后，专家组确定了该研究领域未来的研究方向。
