Prevalence of 2-year “No evidence of disease activity” (NEDA-3 and NEDA-4) in relapsing-remitting multiple sclerosis. A real-world study

• Published in: Multiple sclerosis and related disorders 2023-11, Vol.79, p.105015-105015, Article 105015
• Main Authors: Bazzurri, V., Fiore, A., Curti, E., Tsantes, E., Franceschini, A., Granella, F.
• Format: Article
• Language: English
• Subjects: Brain volume loss; Multiple sclerosis; NEDA-3 - NEDA-4; No evidence of disease activity
• ISSN: 2211-0348; 2211-0356
• DOI: 10.1016/j.msard.2023.105015

•No evidence of disease activity (NEDA) is becoming a gold standard in the evaluation of relapsing-remitting multiple sclerosis (RRMS).•NEDA-3 status is the absence of relapses, new activity on brain MRI, and disability progression. NEDA-4 meets all NEDA-3 criteria plus lack of brain atrophy.•In our cohort 2-year NEDA status, especially including lack of brain atrophy, was hard to achieve.•Application of NEDA-4 in real-world studies evaluating current DMTs might improve treatment strategies in MS. No evidence of disease activity (NEDA) is becoming a gold standard in the evaluation of disease modifying therapies (DMT) in relapsing-remitting multiple sclerosis (RRMS). NEDA-3 status is the absence of relapses, new activity on brain MRI, and disability progression. NEDA-4 meets all NEDA-3 criteria plus lack of brain atrophy. Aim of this study was to investigate the prevalence of two-year NEDA-3, NEDA-4, six-month delayed NEDA-3 (6mdNEDA-3), and six-month delayed NEDA-4 (6mdNEDA-4) in a cohort of patients with RRMS. Six-month delayed measures were introduced to consider latency of action of drugs. Observational retrospective monocentric study. All the patients with RRMS starting DMT between 2015 and 2018, and with 2-year of follow-up, were included. Annualized brain volume loss (a-BVL) was calculated by SIENA software. We included 108 patients, the majority treated with first line DMT. At 2-year follow-up, 35 % of patients were NEDA-3 (50 % 6mdNEDA-3), and 17 % NEDA-4 (28 % 6mdNEDA-4). Loss of NEDA-3 status was mainly driven by MRI activity (70 %), followed by relapses (56 %), and only minimally by disability progression (7 %). In our cohort 2-year NEDA status, especially including lack of brain atrophy, was hard to achieve. Further studies are needed to establish the prognostic value of NEDA-3 and NEDA4 in the long-term follow-up.