Neurological Improvement in Multiple Sclerosis [2018]

Confirmed Disability Improvement (CDI) is a relatively new outcome measure in the more recent MS clinical trials. It is defined as an IMPROVEMENT of at least 1 point on the Expanded Disability Status Scale (EDSS) that is maintained for at least 3 or 6 months (depending on the clinical trial.

In this video I discuss:

-EDSS. This is where we turn the results of a full neuro exam into a number 1-10 for easy "talk-ability". 0 is can't find any deficits and 10 is dead.

-Confirmed Disability Progression (CDP): This is a traditional MS clinical trials outcome measure that is based off of change on the EDSS over time (from trial start to trail completion 2 years later). It is often used to demonstrate that one DMT slows risk of progression of disability by X% compared to something else (placebo or active comparator DMT).

-Confirmed Disability Improvement (CDI): Just like CDP, this metric also uses the EDSS. It measures the "risk" of having the neurological examination GET BETTER for at least 3 or 6 months (depending on the trial).

Presently we have been able demonstrate that some of the MS disease modifying agents can improve the chance of CDI (versus either a dummy drug or a standard of care DMT). This is a new metric and has not been testing in most of the "older drugs." None the less, the CDI data in 2018 is very encouraging. It also, IMHO, begs the questions: should we start to demand MORE from out disease modifying therapies.

What do you think? Should we start to demand MORE from out disease modifying therapies? Please share your thoughts on CDI in Multiple Sclerosis. Good or Not-So-Good, I'd love to hear your thoughts!

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