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Table 2 Risks of untreated relapsing MS

From: Decision making under uncertainty, therapeutic inertia, and physicians’ risk preferences in the management of multiple sclerosis (DIScUTIR MS)

Treatment targets Evidence of association Long-term outcome
T2 lesion volume Increase of 0.8–l ml/year Correlates with increased relapse frequency and long term disability outcomes.
T1 black hole conversion 40–50 % of lesions go on to form black holes Correlation with clinical measures and disability progression.
Brain atrophy 0.5–1 %/year in MS vs. <0.1 % in healthy controls Correlation with cognitive outcomes and EDSS in the long term.
Clinical relapses Annualized relapse rate in placebo arms: 0.5–1.38 Relapses associated with decreased quality of life.
   Relapses associated with accrual of disability.
   Earlier onset of SPMS.
Disability accrual Average change of 0.27 EDSS points/per relapse Increased likelihood of long term disability.
MRI and lesional activity associated with disability progression
  1. Reproduced with permission from Ontaneda et al. [8]