{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T06:36:50Z","timestamp":1771915010645,"version":"3.50.1"},"reference-count":39,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2025,1,21]],"date-time":"2025-01-21T00:00:00Z","timestamp":1737417600000},"content-version":"vor","delay-in-days":28,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100008792","name":"Novartis Pharma","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100008792","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,12,24]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Secondary progressive multiple sclerosis is often categorized as \u2018active\u2019\/\u2018non-active\u2019 based on inflammatory activity on MRI, or relapse; however, the value of MRI\/relapse as indicators of disease activity in real-world and clinical trial settings merits further investigation. We separately analysed retrospective data from patients with clinically diagnosed secondary progressive multiple sclerosis in the Adelphi Real-World Disease Specific Programme (a cross-sectional survey) in multiple sclerosis (Adelphi: n = 2554) and the placebo group of the Phase III EXploring the efficacy and safety of siponimod in PAtients with secoNDary progressive multiple sclerosis (EXPAND) trial, [EXPAND-PBO (placebo group of the EXPAND): n = 546] to assess: differences between active\/non-active disease in the real-world (characteristics; monitoring); the value of MRI and relapse to indicate disease activity; and the number and characteristics of non-active patients with disease activity in the clinical study. In Adelphi, 1889 patients had \u2018active\u2019 disease (\u22651 relapse in the year before index date and\/or \u22651 new lesion on most recent MRI) versus 665 with \u2018non-active\u2019 disease (no relapses in the previous year and no new lesions on MRI); median age was 48 versus 53 years; 73.5 versus 87.8% had moderate-to-severe disease; 75.7 versus 54.3% were taking disease-modifying treatment; 87.7 versus 58.7% had received an MRI in the past year. Most active cases (n = 1116; 59.1%) were identified by MRI versus 239 (12.7%) by relapse and 534 (28.3%) by MRI plus relapse. In EXPAND-PBO, 263 patients were classified \u2018active\u2019 (\u22651 relapse in 2 years before screening and\/or \u22651 gadolinium-enhancing lesion) and 270 \u2018non-active\u2019 (no relapse in the 2 years before screening and no gadolinium-enhancing lesion[s]) at baseline; similar proportions of these groups had received disease-modifying treatment prior to placebo: 77.2 and 80.7%. Of non-active patients, 53.0% had disease activity on study; in these patients, 74.1% had disease activity identified by MRI, 8.4% by relapse, and 17.5% by MRI plus relapse. In patients classified non-active at baseline: age and percentage with Expanded Disability Status Scale score 6.0\u20136.5 were similar between patients with disease activity on study versus patients who remained non-active: 48 versus 52 years; 49.7 versus 56.7%, respectively. In real-world and clinical trial settings, MRI could be a better option than relapse for the identification of disease activity. However, in the real-world, fewer non-active patients had received an MRI in the last year than active patients, which is concerning given that most disease activity in EXPAND-PBO was identified via MRI. We highlight difficulties in consistently identifying disease activity and the negative implications of infrequent monitoring of non-active disease.<\/jats:p>","DOI":"10.1093\/braincomms\/fcaf010","type":"journal-article","created":{"date-parts":[[2025,1,13]],"date-time":"2025-01-13T12:15:37Z","timestamp":1736770537000},"source":"Crossref","is-referenced-by-count":3,"title":["MRI versus relapse: optimal activity monitoring for management of progressive multiple sclerosis"],"prefix":"10.1093","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9995-1700","authenticated-orcid":false,"given":"Gavin","family":"Giovannoni","sequence":"first","affiliation":[{"name":"The Faculty of Medicine and Dentistry, Blizard Institute, Queen Mary University of London , London E1 2AT ,","place":["UK"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Suzannah","family":"Hetherington","sequence":"additional","affiliation":[{"name":"Novartis Pharma AG , Basel CH-4056 ,","place":["Switzerland"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eddie","family":"Jones","sequence":"additional","affiliation":[{"name":"Adelphi Real World , Manchester SK10 5JB ,","place":["UK"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patricia","family":"Dominguez Castro","sequence":"additional","affiliation":[{"name":"Novartis Ireland Ltd , Dublin D04A9N6 ,","place":["Ireland"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Himanshu","family":"Karu","sequence":"additional","affiliation":[{"name":"Novartis Healthcare Pvt. 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