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Abstract
Background and Objectives We conducted a systematic review and meta-analysis to evaluate the relationship between no evidence of disease activity (NEDA) and no long-term disability progression on low- and high-efficacy therapy in relapsing-remitting multiple sclerosis (RRMS).
Methods MEDLINE, Embase, and the Cochrane Database were searched from January 1, 2006, to January 26, 2021. We selected studies that evaluated NEDA-3 (no relapse, new MRI lesion, or confirmed disability progression) at 1 or 2 years and had a minimum of 4 years of follow-up for determination of disability progression. Data were extracted by 2 independent reviewers and were meta-analyzed with a random-effects model. Primary outcome of no disability progression was defined as no confirmed progression on the Expanded Disability Status Scale during follow-up. We assessed the odds ratio (OR) for no disability progression with NEDA vs evidence of disease activity (EDA). Positive predictive value (PPV) of NEDA for no disability progression was summarized for studies with prevalence of no progression >80% vs ≤80% separately.
Results We included 29 studies in our qualitative synthesis, of which 27 (16 low efficacy, 11 high efficacy) were included in the meta-analysis (N = 10,935 participants). Median follow-up was 5.6 years (interquartile range 4.3–8.0 years). The pooled ORs for no progression with NEDA-3 vs EDA were 2.32 (95% CI 1.58–3.42; I2 = 73%) for low-efficacy therapy and 3.19 (95% CI 1.86–5.47; I2 = 86%) for high-efficacy therapy. Among studies with prevalence of no progression at follow-up >80%, the pooled PPV for low efficacy therapy was 91% (95% CI 89%–93%) and for high-efficacy therapy was 92% (95% CI 88%–94%). Among studies with prevalence of no progression ≤80%, the pooled PPV for low-efficacy therapy was 81% (95% CI 75%–86%) and for high-efficacy therapy was 86% (95% CI 80%–90%).
Discussion NEDA-3 is associated with no long-term disability progression in RRMS on both low- and high-efficacy therapies. Further studies of early composite outcome measures incorporating easily measurable biomarkers and longer follow-up may help to improve the prognostic value of NEDA-3 in RRMS.
Trial Registration Information International Prospective Register of Systematic Reviews Identifier: CRD42020189316.
Glossary
- DMT=
- disease-modifying therapy;
- EDA=
- evidence of disease activity;
- EDSS=
- Expanded Disability Status Scale;
- HSCT=
- hematopoietic stem cell transplantation;
- MS=
- multiple sclerosis;
- NEDA=
- no evidence of disease activity;
- NPV=
- negative predictive value;
- OR=
- odds ratio;
- PPV=
- positive predictive value;
- RCT=
- randomized controlled trial;
- RRMS=
- relapsing-remitting multiple sclerosis;
- 6m-CDP=
- 6-month confirmed disability progression
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Submitted and externally peer reviewed. The handling editor was Olga Ciccarelli, MD, PhD, FRCP.
- Received October 12, 2021.
- Accepted in final form March 2, 2022.
- © 2022 American Academy of Neurology
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