Naizer Hayden, Kohl Iii Harold, Krause Trudy, Hamden Randa, Wozny Joseph, Charron Odelin, Freeman Leorah
McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA.
Dell Medical School, The University of Texas at Austin, Austin, TX, USA.
Neuroradiology. 2024 Dec;66(12):2163-2170. doi: 10.1007/s00234-024-03483-z. Epub 2024 Oct 12.
Studies measuring the role of magnetic resonance imaging (MRI) in therapeutic decision-making are rare in people with multiple sclerosis (pwMS). This study aimed to measure the association between MRI utilization and disease-modifying therapy (DMT) switches in pwMS.
This retrospective cohort study identified pwMS in 2018 from a de-identified national claims database. PwMS who received MRI in 2018 were compared to pwMS not receiving MRI in 2018. PwMS were observed for six months to assess the incidence of DMT switches.
The study sample consisted of 11,972 pwMS. 3,931 (32.8%) pwMS received at least one MRI in 2018. Overall, MRI utilization increased the odds of switching DMT (OR = 1.49, 1.79, and 3.01 for 1, 2, and ≥ 3 CNS locations imaged). For those on injectable or platform DMT, any MRI utilization increased the odds of switching DMT (OR = 1.54, 2.00, and 3.48 for 1, 2, and ≥ 3 locations imaged). For those on oral DMT, only receiving MRI of 2 or ≥ 3 locations increased the odds of a DMT switch (OR = 1.36, 1.89, and 2.40 for 1, 2, and ≥ 3 locations). Finally, for pwMS on infusible therapies, there was little evidence that MRI changed the odds of a DMT switch.
Among pwMS on injectable or oral DMT, imaging more CNS locations increased the odds of switching DMT after adjusting for age and relapse incidence. For pwMS on high-efficacy infusible DMTs, MRI did not change the odds of switching DMT but remains essential for safety monitoring.
在多发性硬化症患者（pwMS）中，评估磁共振成像（MRI）在治疗决策中作用的研究较少。本研究旨在测定pwMS中MRI应用与疾病修饰治疗（DMT）转换之间的关联。
这项回顾性队列研究从一个经过去识别处理的全国索赔数据库中确定了2018年的pwMS。将2018年接受MRI检查的pwMS与未接受MRI检查的pwMS进行比较。对pwMS进行为期六个月的观察，以评估DMT转换的发生率。
研究样本包括11,972例pwMS。2018年，3,931例（32.8%）pwMS接受了至少一次MRI检查。总体而言，MRI应用增加了DMT转换的几率（针对1个、2个和≥3个中枢神经系统（CNS）成像部位，比值比（OR）分别为1.49、1.79和3.01）。对于接受注射或平台型DMT治疗的患者，任何MRI应用都增加了DMT转换的几率（针对1个、2个和≥3个成像部位，OR分别为1.54、2.00和3.48）。对于接受口服DMT治疗的患者，仅接受2个或≥3个部位的MRI检查增加了DMT转换的几率（针对1个、2个和≥3个部位，OR分别为1.36、1.89和2.40）。最后，对于接受输注治疗的pwMS，几乎没有证据表明MRI改变了DMT转换的几率。
在接受注射或口服DMT治疗的pwMS中，在调整年龄和复发率后，对更多CNS部位进行成像增加了DMT转换的几率。对于接受高效输注型DMT治疗的pwMS，MRI并未改变DMT转换的几率，但对于安全监测仍然至关重要。
