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In this issue of Neurology®, Kragt et al.1 provide some considerations of multiple sclerosis (MS) outcome measures noting the apparent failure of the MS Functional Composite (MSFC) and Expanded Disability Status Scale (EDSS) to predict subsequent worsening in a group of patients with primary progressive MS (PPMS). These findings tell us about the unpredictable behavior of the disease, the inability to predict in short term horizons, or that MS measures of disability are flawed. If the measures are inadequate, how can we put into context clinical trial results that purport to show benefits based on these measures? If the EDSS cannot be predicted over time, why do we consider this the gold standard for clinically meaningful change? Does this suggest that preventing disability progression as measured by these scales does not translate into real benefits?
Concerns with the study might include that the PPMS …
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