Multiple sclerosis and related disorders · 2026
Predictors of early NEDA-3 status after first disease-modifying therapy in a real-world Brazilian multiple sclerosis cohort.
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Albuquerque Flávia Timbó, de Menezes Felipe Toscano Lins, Bessa Natasha Pryanka de Araújo, de Souza Nilton Amorim, Bichuetti Denis Bernardi, de Oliveira Enedina Maria Lobato
Аннотация
BACKGROUND: No evidence of disease activity (NEDA-3) is widely recognized as a key therapeutic goal in multiple sclerosis (MS), reflecting complete suppression of both clinical and radiological activity. Despite its importance, there is limited real-world evidence on NEDA-3 attainment following the initiation of first-line disease-modifying therapy (DMT), particularly in middle-income countries. This study evaluated the proportion of people with MS (PwMS) who achieved NEDA-3 after the first year of treatment and identified clinical predictors associated with this outcome.
METHODS: We retrospectively analyzed 332 participants with relapsing-remitting MS who initiated their first DMT at a large tertiary neuroimmunology center in São Paulo, Brazil, between 1994 and 2019. NEDA-3 was defined as the simultaneous absence of relapses, confirmed disability progression, and MRI activity after one year. Logistic regression models identified independent predictors of NEDA-3 status.
RESULTS: After one year, 29.2% of participants met NEDA-3 criteria. Lower baseline disability (EDSS ≥3: OR = 0.51, 95% CI: 0.28-0.93; p = 0.027), fewer pre-treatment relapses (OR = 0.84, 95% CI: 0.72-0.98; p = 0.031), and use of moderate/high-efficacy DMTs (OR = 2.94, 95% CI: 1.47-5.88; p = 0.002) increased the likelihood of NEDA-3. In the multivariate model, both pre-treatment relapse counts and DMT efficacy remained independent predictors.
CONCLUSIONS: In this real-world cohort, about one-third met NEDA-3 criteria after the first treatment year. Early disease control was more likely with moderate/high-efficacy therapy and a lower prior inflammatory burden. This result highlights the importance of timely and effective treatment in optimizing long-term MS outcomes.
METHODS: We retrospectively analyzed 332 participants with relapsing-remitting MS who initiated their first DMT at a large tertiary neuroimmunology center in São Paulo, Brazil, between 1994 and 2019. NEDA-3 was defined as the simultaneous absence of relapses, confirmed disability progression, and MRI activity after one year. Logistic regression models identified independent predictors of NEDA-3 status.
RESULTS: After one year, 29.2% of participants met NEDA-3 criteria. Lower baseline disability (EDSS ≥3: OR = 0.51, 95% CI: 0.28-0.93; p = 0.027), fewer pre-treatment relapses (OR = 0.84, 95% CI: 0.72-0.98; p = 0.031), and use of moderate/high-efficacy DMTs (OR = 2.94, 95% CI: 1.47-5.88; p = 0.002) increased the likelihood of NEDA-3. In the multivariate model, both pre-treatment relapse counts and DMT efficacy remained independent predictors.
CONCLUSIONS: In this real-world cohort, about one-third met NEDA-3 criteria after the first treatment year. Early disease control was more likely with moderate/high-efficacy therapy and a lower prior inflammatory burden. This result highlights the importance of timely and effective treatment in optimizing long-term MS outcomes.