Accès ouvert déclaré 2026 article

Treatment escalation after clinically silent MRI lesions in relapsing-remitting multiple sclerosis

Cyrus Daruwalla, Courtney Kremler, Francesco Patti, Serkan Ozakbas, Cavit Boz, Lechner-Scott Js, Andrea Surcinelli, Matteo Foschi, Khoury Sj, H Butzkueven, Anneke Van Der Walt, Zuzana Rous, Mario Habek, J E Meca-Lallana, Gabriel Valero Lopez, Raed Alroughani, Yolanda Blanco, Guy Laureys, Olga Skibina, Katherine A. Buzzard, Orla Gray, Pamela McCombe, Davide Maimone, Pierre Duquette, Marc Girard, Gómez Prat A, Jose Luis Sanchez-Menoyo, Vincent Van Pesch, Aysun Soysal, Maria Pia Amato, Francois Grand'Maison, Judith Wilton, Bart V Wijmeersch, Oliver H. H. Gerlach, Alessandra Lugaresi, Valentina Tomassini, Giovanna De Luca, Bruce Taylor, Yi Chao Foong, Nevin John, Simón Cárdenas‐Robledo, Suzanne Hodgkinson, Richard Macdonell, Barbara M. P. Willekens, Justin Garber, Emanuele D’Amico, Murat Terzi, Jana Houskova, Emmanuelle Lapointe, Abdullah Al-Asmi, Michael Harry Barnett, Ivana Štětkářová, R Gouider, Saloua Mrabet, Tunde Csepany, Chris McGuigan, Katrin Gross‐Paju, Jens Kühle, Tamara Castillo-Triviño, Simon Kerrigan, Aviva M. Tolkovsky, Mark Wardle, Nick G Cunniffe, Izanne Roos, Paul Madley‐Dowd, Alasdair J. Coles, Tomáš Kalinčík, Jonathan A C Sterne, J L William Brown, the MSBase study group, Mark Marriott, Trevor Kilpatrick, John King, Ai‐Lan Nguyen, Chris Dwyer, Vivien Li, Prashanth Ramachandran, Melissa Chu, Lisa Taylor, Katherine Fazzolari, Hasini Fernando, Margaret Bolger, Jersey Higgins, Clara Chisari, Lo Fermo Salvatore, Catherine Larochelle, Raymond Hupperts, Juan Camilo Carrillo, Javier Olascoaga, Jana Libertínová, Marek Paterka, Marta Vachova, Tomas Kalincik, Bassem I. Yamout, Pierre Grammond, Sara Eichau, Guillermo Izquierdo, Daniele L.A. Spitaleri, Jiwon Oh, Pavel Hradílek, Michal Dufek, Silvia Messina, Elisabetta Cartechini, Jennifer Massey, Mark Slee, Joana Guimarães, Maria Edite Rio, Angel Perez sempere, Gregor Brecl Jakob, D. Decoo, José Antonio Cabrera-Gómez, Todd A Hardy, Cauchi Mn, Melissa Cambron, F T Moore, José Andrés Domínguez, Nikolaos Grigoriadis, N Isobe, Jan Mares, Chiyoko Nohara, Masayuki Mizuno, Fumitaka Shimizu, Guntis Karelis, Ayse Altintas, Abdorreza Naser Moghadasi, Talal Al-Harbi, Cristina M. Ramo-Tello, Imre Piroska, Edgardo Cristiano, Cameron Shaw, Neil Shuey, Mike Boggild, Julie Prevost, Seyed Mohammad Baghbanian, Kenzo Sakurai, Eli Skromne, Deborah Mason, Jabir Alkhaboori, Victor Babes Timisoara, Mihaela Simu, Recai Turkoglu, J R Parratt, Nevin Shalaby, Magdolna Simó, Krisztina Kovacs, Attila Sas, Andrea Mike, Yuri Nakamura, Beatriz Romero Ferrando, Canan Yücesan, Oksana Kopchak

0Citations signalées, ce qui n’est pas une note de qualité

86Institutions déclarées

24Pays d’affiliation déclarés

Rattachement africain : gb, pt, it, tr, au, lb, cz, hr, es, kw, be, ca, nl, co, Ouganda, om, ir, Tunisie, hu, ie, ee, ch, cl, sk. Niveau de preuve : code pays fourni par la source.

Le résumé fourni par la source

Clinically silent MRI lesions occur frequently in people with relapsing-remitting multiple sclerosis (RRMS) despite disease modifying therapy (DMT). Guidelines only routinely recommend DMT escalation after multiple silent lesions, and adherence is variable. We explored outcomes and the effect of treatment escalation following single and multiple on-treatment silent lesions. This cohort study and emulated target trial used MSBase registry data from 99 clinics in 26 countries between 2007 and 2025. Clinically stable participants receiving any DMT for RRMS with silent lesions versus without silent lesions were compared. Among participants with silent lesions while taking platform or moderate-efficacy DMTs, outcomes following treatment escalation within 6 months versus no treatment escalation (unless a post-MRI clinical event occurred) were compared. The primary outcome was an MS relapse, and the secondary outcome was 6-month confirmed disability worsening. A total of 10,232 participants met inclusion criteria (71.7% female, mean age 41 [SD 11]). The 2-year cumulative incidence of relapse was 27.8% (95% CI: 25.7%-29.9%) in participants with silent lesions versus 14.3% (95% CI: 13.5%-15.2%) without (adjusted hazard ratio [aHR] 1.76 [95% CI: 1.57-1.97]). The 2-year cumulative incidence of disability worsening was 13.8% (95% CI: 12.2%-15.5%) in participants with silent lesions versus 11.4% (95% CI: 10.7%-12.2%) without (aHR 1.38 [95% CI: 1.18-1.62]). Rates of relapse and disability worsening were higher following single and multiple silent lesions versus no silent lesions. The emulated trial included 2,264 participants with ≥1 silent lesion on platform or moderate efficacy DMTs, 286 of whom escalated DMT within 6 months following silent lesions. The 4-year cumulative incidence of relapse was lower following treatment escalation (16.8% [95% CI: 12.4%-23.4%]) versus continuation (38.9% [95% CI: 35.8%-42.1%]), aHR 0.34 (95% CI: 0.23-0.47), with similar aHRs following single and multiple silent lesions. The 4-year cumulative incidence of disability worsening was similar following treatment escalation (16.0% [95% CI: 10.8%-22.2%]) versus continuation (17.7% [95% CI: 15.3%-20.1%]), aHR 0.89 (95% CI: 0.56-1.33). People with RRMS with single or multiple on-treatment silent MRI lesions have higher subsequent risks of relapse and disability worsening than people without silent lesions. DMT escalation mitigates the relapse risk, though disability worsening continues at a similar rate over 4 years. Contrary to guidelines, DMT escalation should be considered after single or multiple silent lesions.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.

Le contrôle bibliographique ouvert

DOI retrouvé dans Crossref DOI retrouvé ; titre concordant.

Titre Crossref: Treatment escalation after clinically silent MRI lesions in relapsing-remitting multiple sclerosis
Date Crossref: 24/07/2026
Éditeur: Oxford University Press (OUP)
Type: journal-article

Ce recoupement confirme des métadonnées liées au DOI. Il ne confirme ni la méthode ni les conclusions de l’étude, et il ne compte pas comme une seconde source scientifique indépendante.

Où se fait cette recherche

University of Cambridge Cambridge Clinical Multiple Sclerosis Research Group pays non établi dans la notice
Université ou école supérieure
Cambridge School pays non établi dans la notice
Université ou école supérieure
Addenbrooke's Hospital pays non établi dans la notice
Établissement de santé
University of Catania AOU Policlinico G Rodolico-San Marco pays non établi dans la notice
Université ou école supérieure
Policlinico Universitario di Catania pays non établi dans la notice
Établissement de santé
Izmir University pays non établi dans la notice
Université ou école supérieure
İzmir University of Economics pays non établi dans la notice
Université ou école supérieure
Karadeniz Technical University pays non établi dans la notice
Université ou école supérieure
John Hunter Hospital Hunter New England Health pays non établi dans la notice
Établissement de santé
Hunter Medical Research Institute pays non établi dans la notice
Structure de recherche
Ospedale "Santa Maria delle Croci" di Ravenna pays non établi dans la notice
Établissement de santé
University of L'Aquila Department of Biotechnological and Applied Clinical Sciences pays non établi dans la notice
Université ou école supérieure

Cambridge Clinical Multiple Sclerosis Research Group — University of Cambridge, Cambridge School et Addenbrooke's Hospital, avec 9 autres affiliations. Pays d’affiliation : Ouganda, Tunisie.

Une affiliation ne permet pas de déduire la nationalité d’un auteur.

Les sujets associés

Multiple Sclerosis Research StudiesRheumatoid Arthritis Research and TherapiesAdvanced Neuroimaging Techniques and Applications

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