Related Experiment Video
Updated: Jul 28, 2026
The Multiple Sclerosis Performance Test MSPT: An iPad-Based Disability Assessment Tool
Published on: June 30, 2014
Association of No Evidence of Disease Activity With No Long-term Disability Progression in Multiple Sclerosis: A
Dalia Rotstein1, Jacqueline Madeleine Solomon2, Maria Pia Sormani2
1From the Department of Medicine (D.R., A.M.), University of Toronto; St. Michael's Hospital (D.R., A.M.), Toronto; Department of Medicine (J.M.S.), McMaster University, Hamilton, Ontario, Canada; Section of Biostatistics (M.P.S.), Department of Health Sciences, University of Genova; IRCCS Ospedale Policlinico San Martino (M.P.S.), Genova, Italy; Department of Neurology (X.M.), Cemcat, Hospital Universitari Vall d-Hebron, Universitat Autonoma de Barcelona, Spain; Department of Pediatrics (X.Y.Y., P.S.), Mount Sinai Hospital, Toronto, Ontario, Canada; Department of Neurology (D.D.), Columbia University Irving Medical Center; New York Presbyterian Hospital (D.D.), New York City; and Institute of Health, Policy, Management and Evaluation (P.S.), University of Toronto, Ontario, Canada. dalia.rotstein@unityhealth.to.
Background And Objectives:
We conducted a systematic review and meta-analysis to evaluate the relationship between no evidence of disease activity (NEDA) and no long-term disability progression on low- and high-efficacy therapy in relapsing-remitting multiple sclerosis (RRMS).
Methods:
MEDLINE, Embase, and the Cochrane Database were searched from January 1, 2006, to January 26, 2021. We selected studies that evaluated NEDA-3 (no relapse, new MRI lesion, or confirmed disability progression) at 1 or 2 years and had a minimum of 4 years of follow-up for determination of disability progression. Data were extracted by 2 independent reviewers and were meta-analyzed with a random-effects model. Primary outcome of no disability progression was defined as no confirmed progression on the Expanded Disability Status Scale during follow-up. We assessed the odds ratio (OR) for no disability progression with NEDA vs evidence of disease activity (EDA). Positive predictive value (PPV) of NEDA for no disability progression was summarized for studies with prevalence of no progression >80% vs ≤80% separately.
Results:
We included 29 studies in our qualitative synthesis, of which 27 (16 low efficacy, 11 high efficacy) were included in the meta-analysis (N = 10,935 participants). Median follow-up was 5.6 years (interquartile range 4.3-8.0 years). The pooled ORs for no progression with NEDA-3 vs EDA were 2.32 (95% CI 1.58-3.42; I 2 = 73%) for low-efficacy therapy and 3.19 (95% CI 1.86-5.47; I 2 = 86%) for high-efficacy therapy. Among studies with prevalence of no progression at follow-up >80%, the pooled PPV for low efficacy therapy was 91% (95% CI 89%-93%) and for high-efficacy therapy was 92% (95% CI 88%-94%). Among studies with prevalence of no progression ≤80%, the pooled PPV for low-efficacy therapy was 81% (95% CI 75%-86%) and for high-efficacy therapy was 86% (95% CI 80%-90%).
Discussion:
NEDA-3 is associated with no long-term disability progression in RRMS on both low- and high-efficacy therapies. Further studies of early composite outcome measures incorporating easily measurable biomarkers and longer follow-up may help to improve the prognostic value of NEDA-3 in RRMS.
Trial Registration Information:
International Prospective Register of Systematic Reviews Identifier: CRD42020189316.
