MRI as an outcome in multiple sclerosis clinical trials.

Daumer et al.1 found that brain MRI is not a good surrogate marker of medication efficacy and that gadolinium enhancement is not a predictor of relapses in multiple sclerosis (MS). The authors also noted that other studies found either no or weak correlation between disability and MRI change. While brain MRI is invaluable in helping diagnose MS, this study should lead to consideration of the value of the clinical practice of repeated following of the brain MRI, particularly in patients with stable MS. It seems that the MRI should be helpful in following patients with established MS, but the data from Daumer et al.1 and others2–4 dispute this. While some investigators have been more sanguine about the value of MRI in following patients with established MS, they have also noted that there is a paradox of modest correlation between the MRI and relapses at the individual level and better correlation at the trial level.5 This would seem to support the conclusion that in the clinical …

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