Zhao Y, Kondo Y, Traboulsee A, Li DK, Riddehough A, Petkau AJ. Personalized activity index, a new safety monitoring tool for multiple sclerosis clinical trials.
Mult Scler J Exp Transl Clin 2015;
1:2055217315577829. [PMID:
28607690 PMCID:
PMC5433340 DOI:
10.1177/2055217315577829]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 01/30/2015] [Indexed: 11/24/2022] Open
Abstract
Background
An abnormal increase of contrast-enhancing lesion (CEL) counts on frequent MRIs is interpreted as a signal of potential worsening in multiple sclerosis (MS) clinical trials. We demonstrate the utility of the MR personalized activity index (MR-pax) to identify such increases.
Methods
We analyzed a previous Phase II study in relapsing patients (n = 167) with MRIs at screening, baseline and months 1–6. We performed five consecutive reviews at 90-day intervals. At each review, we evaluate the MR-pax for each patient and also identify those who meet the rule-of-five (an ad-hoc guideline currently in use). To evaluate its clinical relevance, we assess the relation between having a small MR-pax (≤0.05; indicating an unexpected CEL increase) and relapse status in the 12 weeks post-review.
Results
Of the 399 patient reviews, 35 cases met the rule-of-five; 35 had an MR-pax ≤ 0.05; 18 met both criteria. The proportions experiencing clinical relapse are 63% among those meeting the rule-of-five, 61% among those with MR-pax ≤0.05, and 83% for those meeting both criteria, more than double the rate of those meeting neither criterion (40%).
Conclusion
A guideline combining this new personalized index and the existing threshold-based criterion is able to better identify patients with a higher risk of experiencing relapses.
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