MS is characterized by acute and diffuse inflammation and chronic neurodegeneration

Adapted from Gavin Giovannoni based on Fox RJ, Cohen JA. Cleve Clin J Med. 2001;68:157-171.

Inflammation is an important driver of progression early in MS 9,12-21
  • Inflammatory activity is thought to be highest early in MS and is correlated with relapses and new lesions
  • These lesions contribute to axonal loss/degeneration, which is associated with disability progression

Recognizing and managing progression early in RMS can be challenging 12

Disability progression in MS patients goes beyond impact on ambulation 22-26
  • Early neurologic deficits can be difficult to evaluate on exam; even tools used in clinical trials, such as the EDSS, may not capture early signs of worsening
    • Additional assessments (eg, SDMT; BDI-II; HADS) may help with earlier identification of subtle changes in function
  • Patients who are still ambulatory can accumulate moderate disability in any 1 of the functional systems or mild disability across several functional systems (which equates to an EDSS of 3.0 in clinical trials)
"Silent" progression can accrue unnoticed early in MS and have lasting consequences 11,12,27-29
  • While relapses can contribute to early neurologic changes in RMS, disability accumulation can often occur in the absence of relapse
  • Once MS patients reach the need for walking assistance (EDSS ≥4.0), some may be at risk for more rapid accumulation of irreversible disability

BDI-II=Beck Depression Inventory-II; EDSS=Expanded Disability Status Scale; Gd+=gadolinium-enhancing; HADS=Hospital Anxiety Depression Scale; PPMS=primary progressive multiple sclerosis; RMS=relapsing multiple sclerosis; SDMT=Symbol Digit Modalities Test.

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Review RMS data in controlled head-to-head trials vs Rebif.

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