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Updated: Mar 14, 2026
Magnetic Resonance Imaging of Multiple Sclerosis at 7.0 Tesla
Published on: February 19, 2021
Lack of magnetic resonance imaging lesion activity as a treatment target in multiple sclerosis: An evaluation using
Devon S Conway1, Nicolas R Thompson2, Jeffrey A Cohen1
1Mellen Center for Multiple Sclerosis Treatment and Research, Neurological Institute, Cleveland Clinic Foundatio, 9500 Euclid Avenue/U10, Cleveland, OH, 44195 USA.
Background:
The appropriate treatment target in multiple sclerosis (MS) is unclear. Lack of magnetic resonance imaging (MRI) lesion activity, a component of the no evidence of disease activity concept, has been proposed as a treatment target in MS. We used our MS database to investigate whether aggressively pursuing MRI stability by changing disease modifying therapy (DMT) when MRI activity is observed leads to better clinical and imaging outcomes.
Methods:
The Knowledge Program (KP) is a database linked to our electronic medical record allowing capture of patient and clinician reported outcomes. Through KP query and chart review, we identified all relapsing-remitting MS patients visiting between 1 January 2008 and 31 December 2014 with active MRIs despite DMT. Propensity modeling based on demographic and disease characteristics was used to match DMT switchers to non-switchers. KP and MRI outcomes were compared 18 months after the active MRI using mixed-effects linear regression models.
Results:
We identified 417 patients who met criteria for our analysis. After propensity matching, 78 switchers and 91 non-switchers were analyzed. There was no difference in clinical or radiologic outcomes between these groups at 18 months.
Conclusions:
We did not find a short-term benefit of changing DMT to pursue MRI stability.
Insights
Changing disease-modifying therapy (DMT) for multiple sclerosis (MS) patients with active MRI scans did not improve clinical or imaging outcomes in the short term. Pursuing MRI stability by switching DMT showed no significant benefit.
Area of Science:
- Neurology
- Immunology
- Radiology
Background:
- The optimal treatment target for multiple sclerosis (MS) remains uncertain.
- No evidence of disease activity (NEDA) is a proposed treatment goal, incorporating MRI lesion stability.
- Investigating the impact of switching disease-modifying therapies (DMTs) upon observing MRI activity is crucial.
Purpose of the Study:
- To determine if actively pursuing MRI stability by switching DMTs in MS patients with active MRI lesions leads to improved clinical and imaging outcomes.
- To evaluate the efficacy of DMT modification as a strategy for achieving NEDA.
Main Methods:
- Utilized the Knowledge Program (KP) database and electronic medical records to identify relapsing-remitting MS patients with active MRIs on DMT between 2008-2014.
- Employed propensity modeling to match patients who switched DMTs with those who did not.
- Compared clinical and MRI outcomes at 18 months post-active MRI using mixed-effects linear regression.
Main Results:
- Analyzed 78 DMT switchers and 91 non-switchers after propensity matching from an initial cohort of 417 patients.
- Found no statistically significant differences in clinical outcomes between the switcher and non-switcher groups at 18 months.
- Observed no significant differences in radiologic outcomes (MRI activity) between the groups at 18 months.
Conclusions:
- Switching DMT to achieve MRI stability did not demonstrate a short-term clinical or imaging benefit in this cohort of MS patients.
- The strategy of aggressively pursuing MRI stability by changing DMT may not be beneficial in the short term for managing MS.
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