“No evidence of disease activity – cognition” in relapsing-remitting multiple sclerosis: recommendation for an extensive assessment of disease activity (P4.389)

Objective: In this study, it has hypothesized that brain volume loss leads to cognitive impairment, therefore we aimed to test the addition of cognitive assessment to no evidence of disease activity (NEDA). Background: NEDA was evaluated as the proportion of patients free from relapses and 3-month confirmed disability progression, free from gadolinium-enhancing T1 lesions and new or newly enlarged T2 lesions in magnetic resonance imaging (MRI). Recently, the adding of absence of brain volume loss more than 0.4% has been recommended (NEDA-4). Design/Methods: Patients with RRMS were included in the study. These parameters were assessed: relapse-free period, absence of disease progression on the Expanded Disability Status Scale (EDSS) for 6-month period, absence of new T2, T1 enhancing Gd, and black hole. In addition to these parameters, absence of decreasing more than 10% on any cognitive test from the BICAMS was added and the NEDA – cognition (NEDA – Cog) was developed. The comparisons were done between the baseline and after the 2-year follow-up parameters. Results: In total, 349 patients (285 female) who started the treatment participated in the study between November 2012 and March 2014. Mean age and disease duration were 36.4 and 7.2 years, respectively. NEDA was found in 75.1% of patients (262 patients), and NEDA – Cog was found in 73.9% of patients (258 patients) at the end of 2 years. Patients with less than 2-year elapsed time since disease onset to start of treatment had more NEDA-3 (78.8%) compared to patients with more than 5-year elapsed time to start of treatment (69.1%) (p=0.014). The difference in NEDA – Cog was more significant (76.2% and 59.4%), respectively (p Conclusions: In conclusion, in this preliminary results of our study, the NEDA with cognitive impairment (NEDA-Cog) seems a more sensitive method. The findings suggest that starting treatment later restricts the management of the disease activity. Disclosure: Dr. Ozakbas has nothing to disclose. Dr. Piri Cinar has nothing to disclose. Dr. Yigit has nothing to disclose. Dr. Kosehasanogullari has nothing to disclose.