title: Clinical consequences of MRI activity in treated multiple sclerosis.
abstract: BACKGROUND
  Inflammation on brain MRI is the most sensitive marker of disease activity in multiple sclerosis (MS) but its clinical consequences remain controversial.
  
  
  OBJECTIVE
  Here we investigated the clinical consequences of MRI activity in MS subjects treated with two different first line disease modifying agents.
  
  
  METHODS
  Seventy-five treatment-naïve subjects with relapsing-remitting MS (N = 61) or clinically isolated syndromes at risk of MS (N = 14) from the BECOME study that had been randomized to interferon beta-1b (N = 39) or glatiramer acetate (N = 36) and followed for up to two years by monthly brain MRI optimized to detect inflammatory activity were studied for the clinical consequences of lack of MRI remission.
  
  
  RESULTS
  MRI remission occurred in 46.4% of participants transiently and in 23.2% completely while it was never achieved in 30.4%. There was no difference by treatment in MRI remission, progression of physical disability, or cognitive function. The percentage of relapse-free subjects was 87.5% for the group in complete MRI remission, 47.6% in the group never in remission and 59.4% in the group in transient remission (p = 0.017). Similar differences were observed for six-month-confirmed worsening of ambulatory function as measured by the timed 25 foot walk (p = 0.026) and by Expanded Disability Status Scale (EDSS) (p = 0.10). Cognitive function was lowest at baseline for the group that never reached MRI remission on treatment; this group improved the least upon repeated cognitive testing during the two years of treatment (p < 0.001).
  
  
  CONCLUSIONS
  Lack of MRI remission during treatment with interferon beta-1b or glatiramer acetate is associated with higher relapse rate and worsening of physical and cognitive function.
authors: Department of Neurology and Neuroscience, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, USA. cadavidi@umdnj.edu
authors: Diego
authors: D
authors: Cadavid
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