Guevara Carlos, Garrido Cristian, Martinez Melissa, Farias Gonzalo A, Orellana Patricia, Soruco Wendy, Alarcón Pablo, Diaz Violeta, Silva Carlos, Kempton Matthew J, Barker Gareth, de Grazia José
Faculty of Medicine, Hospital Clínico José Joaquín Aguirre, Santos Dummont, Universidad de Chile, Santiago, Chile.
Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom.
Front Neurol. 2019 Jul 24;10:788. doi: 10.3389/fneur.2019.00788. eCollection 2019.
In relapsing-remitting multiple sclerosis, no evidence of disease activity-3 (NEDA-3) is defined as no relapses, no disability progression and no MRI activity. NEDA-4 status is defined as meeting all NEDA-3 criteria plus having an annualized brain volume loss (a-BVL) of ≤0.4%. Prospective real-world studies presenting data on NEDA-4 are scarce. To determine the proportion of patients failing to meet one or more NEDA-4 criteria and the contribution of each component to this failure. Forty-eight patients were followed for 12 months. Structural image evaluation, using normalization, of atrophy was used to assess a-BVL. The patients had a mean age of 33.0 years (range 18-57), disease duration of 1.7 years (0.4-4) and Expanded Disability Status Scale score of 1.3 (0-4); 71% were women. All patients were on disease-modifying therapies. During follow-up, 21% of the patients had at least one relapse, 21% had disability progression, 8% had new T2 lesions, and 10% had gadolinium-enhanced lesions. Fifty-eight percent (28/48) achieved NEDA-3 status. a-BVL of >0.4% was observed in 52% (25/48). Only 29% (14/48) achieved NEDA-4 status. a-BVL is a good marker to detect subclinical disease activity. a-BVL is parameter to continue investigating for guiding clinical practice in relapsing-remitting multiple sclerosis.
在复发缓解型多发性硬化症中，无疾病活动证据-3（NEDA-3）被定义为无复发、无残疾进展且无MRI活动。NEDA-4状态被定义为符合所有NEDA-3标准，外加年化脑容量损失（a-BVL）≤0.4%。目前缺乏呈现NEDA-4数据的前瞻性真实世界研究。为了确定未达到一项或多项NEDA-4标准的患者比例以及每个组成部分对这种未达标的影响。对48例患者进行了12个月的随访。使用标准化的萎缩结构图像评估来评估a-BVL。患者的平均年龄为33.0岁（范围18 - 57岁），病程为1.7年（0.4 - 4年），扩展残疾状态量表评分为1.3（0 - 4）；71%为女性。所有患者均接受疾病修正治疗。在随访期间，21%的患者至少有一次复发，21%有残疾进展，8%有新的T2病变，10%有钆增强病变。58%（28/48）的患者达到NEDA-3状态。52%（25/48）的患者观察到a-BVL>0.4%。只有29%（14/48）的患者达到NEDA-4状态。a-BVL是检测亚临床疾病活动的良好标志物。a-BVL是在复发缓解型多发性硬化症中继续进行研究以指导临床实践的一个参数。
