No evidence of disease activity (NEDA), also referred to as freedom from disease activity, is a new goal that is emerging in multiple sclerosis treatment. The aim is to treat people with relapsing remitting MS (RRMS) with disease modifying drugs (DMDs) to reach a point where they are having:
In the past, treatment of people with RRMS has been focused solely on reducing the number of relapses. However, relapses may not be a sufficient indicator of MS activity. The inflammation caused by MS does not always result in a relapse or any visible symptoms. This silent MS activity may mean that there are changes caused by your MS that can only be seen on a brain scan. The aim of NEDA is to reach a point where you are free of the visible as well as the silent MS disease activity.
This concept of being ‘disease free’ is based on a treatment approach that has been found to be successful in the treatment of people with cancer and rheumatoid arthritis. The idea is to start disease modifying drug (DMD) treatment as soon as possible after diagnosis to prevent a build-up of symptoms and nerve damage. If you do not respond to treatment and MS activity is detected then your treatment would be reviewed to consider switching to another drug which may be more effective.
The concept of NEDA is new and still evolving. There is debate over additional measures of disease activity that could or should be included in the definition. As understanding of what causes MS continues to develop, monitoring the effect of DMD treatment will change.
Whilst a growing number of neurologists with a specialist interest in MS are encouraging this early, proactive approach to managing RRMS, not all neurologists will take the same view and some national guidance does not yet reflect this strategy. It is important that people with RRMS raise the issue of early treatment and how it might apply to their MS and work closely with their neurologist and MS nurse to make the choice that is right for them.