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Related Concept Videos

Multiple Sclerosis l: Introduction01:19

Multiple Sclerosis l: Introduction

Multiple sclerosis is a chronic autoimmune disease of the central nervous system (CNS) that affects the brain, spinal cord, and optic nerves. It is an inflammatory demyelinating disorder and a leading cause of neurological disability in young adults.EpidemiologyMS commonly begins between 20 and 40 years of age and is twice as common in women. Its exact cause remains unclear, but genetic susceptibility contributes, with higher risk in first-degree relatives and identical twins. A greater...

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Related Experiment Video

Updated: Jun 11, 2026

The Multiple Sclerosis Performance Test (MSPT): An iPad-Based Disability Assessment Tool
11:35

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Published on: June 30, 2014

Defining Activity-Based Subgroups in Multiple Sclerosis: A Review and Framework Proposal.

Catalina Lopez Manzano1, Claire M Rice2,3, Emma Tallantyre4

  • 1Bristol Technology Assessment Group (TAG), Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.

European Journal of Neurology
|June 10, 2026
PubMed
Summary
This summary is machine-generated.

Inconsistent definitions for multiple sclerosis (MS) activity subgroups hinder treatment access. This study proposes a standardized framework for

Keywords:
clinical trialsevidence synthesismultiple sclerosisrelapsing–remittingreview

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Area of Science:

  • Neurology
  • Clinical Trials
  • Health Technology Assessment

Background:

  • Multiple sclerosis (MS) is stratified into activity-based subgroups to guide treatment and health technology assessments (HTAs).
  • Current terminology and criteria for 'active', 'highly active', and 'rapidly evolving severe' (RES) MS disease lack consistency across clinical trials and regulatory guidance.
  • This inconsistency creates ambiguity in clinical practice and limits patient access to treatments.

Purpose of the Study:

  • To review definitions of activity-based MS subgroups within NICE technology appraisals (TAs) and their supporting randomized controlled trials (RCTs).
  • To propose a preliminary framework for standardized terminology to address current inconsistencies.

Main Methods:

  • Systematic review of NICE TAs for disease-modifying therapies in MS and the RCTs cited within them.
  • Extraction and comparative analysis of definitions for MS activity subgroups based on relapse history, MRI findings, and treatment status.
  • Classification of definitions to identify consensus and areas of controversy.

Main Results:

  • Significant variation in definitions was observed, particularly for 'highly active' relapsing-remitting MS (RRMS) and active secondary progressive MS (SPMS).
  • While NICE TAs showed some consistency for 'active' and 'RES' RRMS, definitions within RCTs were heterogeneous.
  • A simplified framework with three overlapping subgroups for relapsing MS (RMS) was proposed: active RRMS/RRMS, highly active RRMS (HARRMS), and rapidly evolving severe RRMS (RES-RRMS).

Conclusions:

  • Standardized definitions are crucial for improving evidence synthesis, regulatory clarity, and equitable patient access to MS therapies.
  • A formal consensus process is recommended to solidify the proposed framework for future research, HTAs, and clinical pathways.
  • Implementing standardized terminology will enhance the reliability of MS disease stratification and treatment decision-making.