A recent study provides compelling Class III evidence for the value of MRI metrics in guiding treatment decisions for clinically stable relapsing multiple sclerosis (RMS) patients. The study, which examined the data of 131 participants with RMS across 5 multiple sclerosis (MS) centers in Austria and Switzerland, found that escalating disease-modifying treatment (DMT) based solely on MRI activity could improve clinical outcomes.

Results showed that patients who continued on low-to-moderate-efficacy DMT despite new T2 lesions (T2L) on MRI had a significantly increased risk of relapse: a 3-fold increased risk for patients with 2 new T2L (hazard ratio [HR], 3.2; lower limit of 95% CI [LL-CI], 1.5) and a 4-fold increased risk with ≥3 new T2L (HR, 4.0; LL-CI 2.1). In comparison, escalating DMT in patients with 2 new T2L reduced relapse risk by 80% (HR, 0.2; upper limit of 95% CI [UL-CI], 1.3) and reduced relapse risk by 70% in patients with ≥3 new T2L (HR, 0.3; UL-CI, 0.8).

The findings suggest that MRI-guided treatment escalation could substantially decrease the risk of future relapses for RMS patients.

Bsteh G, Aicher ML, Walde JF, et al. Association of disease-modifying treatment with outcome in patients with relapsing multiple sclerosis and isolated MRI activity. Neurol. 2024;103(6). doi:10.1212/WNL.0000000000209752.