title: Lack of magnetic resonance imaging lesion activity as a treatment target in multiple sclerosis: An evaluation using electronically collected outcomes.
abstract: BACKGROUND
  The appropriate treatment target in multiple sclerosis (MS) is unclear. Lack of magnetic resonance imaging (MRI) lesion activity, a component of the no evidence of disease activity concept, has been proposed as a treatment target in MS. We used our MS database to investigate whether aggressively pursuing MRI stability by changing disease modifying therapy (DMT) when MRI activity is observed leads to better clinical and imaging outcomes.
  
  
  METHODS
  The Knowledge Program (KP) is a database linked to our electronic medical record allowing capture of patient and clinician reported outcomes. Through KP query and chart review, we identified all relapsing-remitting MS patients visiting between 1 January 2008 and 31 December 2014 with active MRIs despite DMT. Propensity modeling based on demographic and disease characteristics was used to match DMT switchers to non-switchers. KP and MRI outcomes were compared 18 months after the active MRI using mixed-effects linear regression models.
  
  
  RESULTS
  We identified 417 patients who met criteria for our analysis. After propensity matching, 78 switchers and 91 non-switchers were analyzed. There was no difference in clinical or radiologic outcomes between these groups at 18 months.
  
  
  CONCLUSIONS
  We did not find a short-term benefit of changing DMT to pursue MRI stability.
authors.affiliation: Mellen Center for Multiple Sclerosis Treatment and Research, Neurological Institute, Cleveland Clinic Foundatio, 9500 Euclid Avenue/U10, Cleveland, OH, 44195 USA. Electronic address: conwayd2@ccf.org.
authors.forename: Devon S
authors.initials: DS
authors.lastname: Conway
authors.affiliation: Department of Quantitative Health Sciences, Neurological Institute Center for Outcomes Research and Evaluation, Cleveland Clinic Foundation, 9500 Euclid Avenue/JJ3, Cleveland, OH, 44195 USA.
authors.forename: Nicolas R
authors.initials: NR
authors.lastname: Thompson
authors.affiliation: Mellen Center for Multiple Sclerosis Treatment and Research, Neurological Institute, Cleveland Clinic Foundatio, 9500 Euclid Avenue/U10, Cleveland, OH, 44195 USA.
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Cohen
mesh_terms: D000328:Adult; D057915:Drug Substitution; D005260:Female; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use; D016014:Linear Models; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000000981:diagnostic imaging* / Q000188:drug therapy* / Q000453:epidemiology; D062606:Tertiary Care Centers; D016896:Treatment Outcome
chemical_list: D007155:Immunologic Factors
keywords: Database; Disease modifying therapy management; Magnetic resonance imaging; Multiple sclerosis; Patient reported outcomes; Treatment target