Monitoring and Treatment of Relapsing-Remitting Multiple Sclerosis

MRI Monitoring and Disease Activity

The American Academy of Neurology recommends initial MRI assessment at 3-6 months after initiating disease-modifying therapy (DMT) to monitor disease activity 1
For patients with active disease, MRI should be performed every 6 months for the first 1-2 years, and then transition to annual MRI if the disease is stable 1
Consistent MRI protocols with T2-weighted sequences and gadolinium enhancement should be used to monitor disease activity 1
Non-enhancing lesions on T2-weighted sequences still represent active MS disease, and new non-enhancing lesions indicate disease progression and warrant treatment intensification 1

The National Multiple Sclerosis Society suggests that AHSCT may be considered for highly active relapsing-remitting MS refractory to DMTs in patients under 45 years with disease duration less than 5 years 2
Optimal candidates for AHSCT have recent inflammatory activity documented on MRI, lower baseline EDSS scores, and short disease duration 2
AHSCT outcomes include progression-free survival of 80-100% in relapsing-remitting MS cohorts, and no evidence of disease activity (NEDA) in 70-80% of patients 2
Long-term outcomes of AHSCT show 87% progression-free survival at 10 years, with transplant-related mortality of 1.4% 2