This concept evolved from rheumatology. No evidence of disease activity is defined as no new MRI lesions, no relapses, no disability worsening. In many studies, the percentage of patients achieving this in the first 2 years varies from 28% to 42%.

In a new study, published in JAMA Neurology, February 2015, 46% of patients achieved no disease activity status after 1 year, but only 8% maintained this at 7 years. Even drugs thought to be very effective, such as Tysabri or Lemtrada, showed no disease activity in only 37% of patients. Gilenya’s numbers were 33%. Copaxone and interferons were about 20%.

The stem cell transplant study termed HALT-MS led to 75% no evidence of disease activity after 3 years; however, it is not a cure, and 25% of patients showed evidence of recurrence.

We are far from achieving this benchmark, but it should be the goal for MS patients.

Jack Florin, MD

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