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Highly active multiple sclerosis - An important, yet inaccurate concept
Alexandre Bussinger Lopes1, Denis Bernardi Bichuetti1, Nilton Amorim de Souza1
1Neurology Department, Federal University of São Paulo, São Paulo, Brazil.
Background:
Multiple sclerosis (MS) is a chronic demyelinating disease that often leads to disability in young adults. Among its various phenotypes, highly active MS (HA-MS) presents with frequent relapses, incomplete recovery, and a high burden of MRI lesions. Despite its clinical importance, there is no universally accepted definition of HA-MS, which complicates early identification and treatment decisions.
Objective:
This study aimed to evaluate whether Brazilian neurologists can recognize HA-MS and whether there is agreement regarding its defining characteristics. It also explored how this recognition influences treatment choices.
Methods:
A cross-sectional, self-administered online survey was distributed to neurologists affiliated with the Brazilian Academy of Neurology (ABN). The questionnaire was open from March to September 2023. Responses were analyzed using descriptive statistics and chi-square or Fisher's exact tests.
Results:
A total of 206 neurologists completed the survey. Most respondents agreed that signs of high disease activity influence therapeutic decisions (98.1%). The most frequently cited indicators of HA-MS were annualized relapse rate (37.4%) and the number of gadolinium-enhancing lesions on MRI (32.0%). The Rush et al. definition was most commonly endorsed (53.9%), while Tintoré's was least favored (85.9%). High-efficacy therapies-particularly Natalizumab, Ocrelizumab, and Alemtuzumab-were the preferred treatment options. Neuroimmunologists were significantly more likely to prescribe advanced therapies and less likely to use first-line agents compared to general neurologists.
Conclusion:
Brazilian neurologists show substantial agreement in identifying clinical and radiological signs of HA-MS and favor early, high-efficacy treatment strategies. These findings highlight the need for clear, standardized criteria to guide consistent diagnosis and timely therapeutic intervention, ultimately improving patient care in MS.
Insights
Brazilian neurologists can identify highly active multiple sclerosis (HA-MS) and agree on treatment strategies. Standardized criteria are needed for consistent diagnosis and timely intervention in HA-MS patients.
Area of Science:
- Neurology
- Immunology
- Clinical Medicine
Background:
- Multiple sclerosis (MS) is a chronic demyelinating disease causing disability in young adults.
- Highly active MS (HA-MS) is a severe phenotype with frequent relapses and high lesion burden.
- Lack of a universal HA-MS definition complicates early diagnosis and treatment.
Purpose of the Study:
- To assess Brazilian neurologists' recognition of HA-MS.
- To evaluate agreement on HA-MS defining characteristics.
- To explore the impact of HA-MS recognition on treatment choices.
Main Methods:
- Cross-sectional online survey distributed to neurologists affiliated with the Brazilian Academy of Neurology (ABN).
- Data collected from March to September 2023.
- Statistical analysis using descriptive statistics and chi-square or Fisher's exact tests.
Main Results:
- 206 neurologists responded; 98.1% agreed disease activity influences treatment.
- Annualized relapse rate and gadolinium-enhancing MRI lesions were key indicators.
- Rush et al. definition was favored; high-efficacy therapies (Natalizumab, Ocrelizumab, Alemtuzumab) were preferred.
Conclusions:
- Brazilian neurologists demonstrate consensus in identifying HA-MS clinical and radiological signs.
- There is a preference for early, high-efficacy treatment strategies for HA-MS.
- Standardized criteria are crucial for consistent diagnosis and timely intervention in MS care.
