NEDA or “No Evidence Of Disease Activity” is an emerging goal in relapsing-remitting multiple sclerosis (RRMS) treatment and management. While no cure exists for RRMS or the progressive courses of the disease (secondary and primary progressive MS) respective many medications now exist for the relapsing-remitting course of the disease.
Scant years back treatment of people who endure life with RRMS had clinical focus placed upon reduction of exacerbations (attacks) called relapses. The problem with this is that relapses are not necessarily an indicator of disease progression or disease activity. As the central nervous system (CNS) consisting of the brain, spinal cord and optic nerves are attacked by the patients immune system resulting in inflammation and damage to nerve cells in the CNS symptoms may not always be visible. This invisible or sometimes called “silent” disease activity can generally only be shown on a magnetic resonance imaging scan (MRI) presently.
Newly developed mechanisms currently in research hope to not only see progression without an MRI scan but also help predict the course of the disease.
NEDA – Treat To Target:
NEDA is considered a “treat to target” concept by which a patient has MRI scans that show no new plaques often called “lesions” where disease activity has taken place.
This sort of treatment approach has made a difference in several diseases such as cancer or rheumatoid arthritis, epilepsy, and diabetes.
Using disease modifying drugs which are not cures but instead attempt to modify the diseases course by stopping disease activity the treatment paradigm in NEDA is to halt disease progression using MRI scans to confirm NEDA.
The goals of NEDA-3 are as follows:
- Having no relapses.
- No increase of accrued disability.
- No new or active plaques (lesions) in MRI scans.
NEDA-3 targets the above three aspects of disease management.
NEDA-4 has also emerged which attempts to target no evidence of brain atrophy (shrinkage).
In relapsing-remitting multiple sclerosis there now are many disease modifying drugs (DMD’s).
The NEDA protocol is to start on a treatment as soon as possible after a positive diagnosis of RRMS to prevent disability and nerve damage in the central nervous system. Should the patient not respond well to the treatment it should be reviewed and switching to a differing medication that may be more effective considered.
NEDA is still an evolving concept and there is some debate over other measures of disease activity that might or should be included.
NEDA is a more proactive approach to relapsing-remitting MS management and not all neurologists are accepting of NEDA. Some nations healthcare systems have not yet accepted the concept of NEDA which also influences what clinicians can engage in.
NEDA is an important discussion to have with your neurologist whether you are newly diagnosed or have some levels of existing disability and you are an RRMS patient.
You should also examine the document shown called “MS Brain Health Matters.”
Neuroimmunologist Dr. Aaron Boster from OhioHealth’s State Of The Art Multiple Sclerosis Center Discusses NEDA.