Related Experiment Video
Updated: Dec 30, 2025
The Multiple Sclerosis Performance Test MSPT: An iPad-Based Disability Assessment Tool
Published on: June 30, 2014
Minimal evidence of disease activity (MEDA) in relapsing-remitting multiple sclerosis
Luca Prosperini1, Chiara Mancinelli2, Shalom Haggiag3
1Multiple Sclerosis Center, San Camillo-Forlanini Hospital, Roma, Italy luca.prosperini@gmail.com.
Objective:
This study aimed to define the minimal evidence of disease activity (MEDA) during treatment that can be tolerated without exposing patients with relapsing-remitting multiple sclerosis at risk of long-term disability.
Methods:
We retrospectively collected data of patients followed up to 10 years after starting interferon beta or glatiramer acetate. Survival analyses explored the association between the long-term risk of reaching an Expanded Disability Status Scale≥6.0 and early clinical and MRI activity assessed after the first and second year of treatment. Early disease activity was classified by the so-called 'MAGNIMS score' (low: no relapses and <3 new T2 lesions; medium: no relapses and ≥3 new T2 lesions or 1 relapse and 0-2 new T2 lesions; high: 1 relapse and ≥3 new T2 lesions or ≥2 relapses) and the absence or presence of contrast-enhancing lesions (CELs).
Results:
At follow-up, 148/1036 (14.3%) patients reached the outcome: 61/685 (8.9%) with low score (reference category), 57/241 (23.7%) with medium score (HR=1.94, p=0.002) and 30/110 (27.3%) with high score (HR=2.47, p<0.001) after the first year of treatment. In the low score subgroup, the risk was further reduced in the absence (49/607, 8.1%) than in the presence of CELs (12/78, 15.4%; HR=2.11, p=0.01). No evident disease activity and low score in the absence of CELs shared the same risk (p=0.54). Similar findings were obtained even after the second year of treatment.
Conclusions:
Early marginal MRI activity of one to two new T2 lesions, in the absence of both relapses and CELs, is associated with a minor risk of future disability, thus representing a simple and valuable definition for MEDA.
Insights
Minimal evidence of disease activity (MEDA) in relapsing-remitting multiple sclerosis patients, defined by low MRI activity and no relapses, is associated with a reduced risk of long-term disability. This finding helps define tolerable treatment targets without compromising patient outcomes.
Area of Science:
- Neurology
- Immunology
- Radiology
Background:
- Relapsing-remitting multiple sclerosis (RRMS) requires careful management to prevent long-term disability.
- Defining minimal evidence of disease activity (MEDA) is crucial for optimizing treatment strategies.
- Early identification of disease activity can inform prognosis and treatment adjustments.
Purpose of the Study:
- To define the minimal evidence of disease activity (MEDA) during treatment for RRMS.
- To determine if early treatment activity predicts long-term disability risk.
- To establish a tolerable MEDA threshold that minimizes disability progression.
Main Methods:
- Retrospective analysis of 1036 RRMS patients treated with interferon beta or glatiramer acetate for up to 10 years.
- Survival analysis to assess the association between early disease activity (first/second year) and reaching an Expanded Disability Status Scale (EDSS) of ≥6.0.
- Classification of early disease activity using the MAGNIMS score (based on relapses and new T2 lesions) and presence of contrast-enhancing lesions (CELs).
Main Results:
- 14.3% of patients reached the EDSS ≥6.0 outcome.
- Patients with 'medium' (HR=1.94) and 'high' (HR=2.47) MAGNIMS scores after year 1 had significantly higher disability risk compared to the 'low' score group.
- In the 'low' score group, absence of CELs further reduced disability risk (8.1%) compared to presence of CELs (15.4%).
Conclusions:
- Early marginal MRI activity (1-2 new T2 lesions) without relapses or CELs indicates a minor risk of future disability.
- This definition of MEDA is simple, valuable, and can guide treatment decisions in RRMS.
- Maintaining minimal disease activity is key to preventing long-term disability progression in MS patients.
