Prediction in treatment outcomes in multiple sclerosis: challenges and recent advances

ABSTRACT

Introduction

Multiple Sclerosis (MS) is a chronic autoimmune and neurodegenerative disease of the central nervous system with a course dependent on early treatment response. Increasing evidence also suggests that despite eliminating disease activity (relapses and lesions), many patients continue to accrue disability, highlighting the need for a more comprehensive definition of treatment success. Optimizing disability outcome measures, as well as continuously improving our understanding of neuroinflammatory and neurodegenerative biomarkers is required.

Areas covered

This review describes the challenges inherent in classifying and monitoring disease phenotype in MS. The review also provides an assessment of clinical, radiological, and blood biomarker tools for current and future practice.

Expert Opinion

Emerging MRI techniques and standardized patient outcome assessments will increase the accuracy of initial diagnosis and understanding of disease progression.

KEYWORDS:

• Treatment response
• treatment prediction
• multiple sclerosis
• outcome measures

Article highlights

• Despite the availability of highly effective disease modifying therapies, patients may accrue disability with heterogenous response to therapy

• Disease progression independent of relapse activity accounts for a larger amount of disability accumulation than previously suspected

• Technology enabled assessments, such as the Multiple Sclerosis Performance Test (a novel iPad-based assessment), standardize individual patient monitoring and can be used for large clinical and data research applications

• Recent MRI advance our ability to reveal markers for progressive pathology and disability accumulation (paramagnetic rim of chronic active lesions, and gray matter volumes)

• Promising fluid biomarkers may predict treatment response (serum neurofilament light) and highlight disease progression (serum glial fibrillary acidic protein)

• Results from ongoing trials will provide guidance on the optimal initial treatment approach (DELIVER-MS, TREAT-MS) and the safety of permanent immune therapy cessation in the aging MS population (DISCOMS)

Declaration of Interests

D Ontaneda receives research support from the National Institutes of Health, National Multiple Sclerosis Society, Patient Centered Outcomes Research Institute, Race to Erase MS Foundation, Genentech, Genzyme, and Novartis. D Ontaneda also receives consulting fees from Biogen Idec, Genentech/Roche, Genzyme, Janssen, Novartis, and Merck. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Additional information

Funding

This paper is not funded.