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Regression to the Mean and Predictors of MRI Disease Activity in RRMS Placebo Cohorts - Is There a Place for Baseline-to-Treatment Studies in MS?

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  • Jan-Patrick Stellmann
  • Klarissa Hanja Stürner
  • Kim Lea Young
  • Susanne Siemonsen
  • Tim Friede
  • Christoph Heesen

Abstract

Background: Gadolinium-enhancing (GD+) lesions and T2 lesions are MRI outcomes for phase-2 treatment trials in relapsing-remitting Multiple Sclerosis (RRMS). Little is known about predictors of lesion development and regression-to-the-mean, which is an important aspect in early baseline-to-treatment trials. Objectives: To quantify regression-to-the-mean and identify predictors of MRI lesion development in placebo cohorts. Methods: 21 Phase-2 and Phase-3 trials were identified by a systematic literature research. Random-effects meta-analyses were performed to estimate development of T2 and GD+ after 6 months (phase-2) or 2 years (phase-3). Predictors of lesion development were evaluated with mixed-effect meta-regression. Results: The mean number of GD+-lesions per scan was similar after 6 months (1.19, 95%CI: 0.87-1.51) and 2 years (1.19, 95%CI: 1.00-1.39). 39% of the patients were without new T2-lesion after 6 month and 19% after 2 years (95%CI: 12-25%). Mean number of baseline GD+-lesions was the best predictor for new lesions after 6 months. Conclusion: Baseline GD-enhancing lesions predict evolution of Gd- and T2 lesions after 6 months and might be used to control for regression to the mean effects. Overall, proof-of-concept studies with a baseline to treatment design have to face a regression to 1.2 GD+lesions per scan within 6 months.

Suggested Citation

  • Jan-Patrick Stellmann & Klarissa Hanja Stürner & Kim Lea Young & Susanne Siemonsen & Tim Friede & Christoph Heesen, 2015. "Regression to the Mean and Predictors of MRI Disease Activity in RRMS Placebo Cohorts - Is There a Place for Baseline-to-Treatment Studies in MS?," PLOS ONE, Public Library of Science, vol. 10(2), pages 1-14, February.
    • Handle: RePEc:plo:pone00:0116559
    DOI: 10.1371/journal.pone.0116559
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    1. David Moher & Alessandro Liberati & Jennifer Tetzlaff & Douglas G Altman & The PRISMA Group, 2009. "Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement," PLOS Medicine, Public Library of Science, vol. 6(7), pages 1-6, July.
    2. Viechtbauer, Wolfgang, 2010. "Conducting Meta-Analyses in R with the metafor Package," Journal of Statistical Software, Foundation for Open Access Statistics, vol. 36(i03).
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    1. Christian Röver & Richard Nicholas & Sebastian Straube & Tim Friede, 2015. "Changing EDSS Progression in Placebo Cohorts in Relapsing MS: A Systematic Review and Meta-Regression," PLOS ONE, Public Library of Science, vol. 10(9), pages 1-10, September.

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