OFSEP Very High Definition Cohort

Study Overview
=================
Brief Summary
-----------------
Multiple sclerosis (MS) is the most common acquired neurological disease leading to disability in young adults. MS often leads to the development of a physical and/or cognitive impairment that disables patients in their daily lives. Early use of disease modifying treatments for patients at risk of developing disability is therefore essential. However, disability progression is very heterogeneous between patients and currently impossible to predict at the individual level. Thus, numerous studies, particularly epidemiological and imaging studies, have identified prognostic factors for the development of disability such as age, gender, number of relapses during the first years of the disease, existence of a residual disability after a first relapse, number of gadolinium-enhancing lesions on initial MRI, early brainstem and spinal cord lesions. However, these different factors only explain incompletely the progression of the physical or cognitive disability in MS patients. In particular, some components of MS pathophysiology, more related to the progressive development of disability, such as axonal degeneration or the existence of chronic inflammation of the central nervous system (CNS) are usually not measured by these biomarkers. In this research project, the investigators will test promising biomarkers, focused on these components of the disease, on a large cohort of patients in a multicenter setting, in order to evaluate their added value to predict disability progression, in comparison with more classical biomarkers such as clinical characteristics, and brain and spinal cord lesion load. In particular, the investigators will test: Imaging biomarkers extracted from brain and spinal cord MP2RAGE, brain and spinal cord QSM, brain and spinal cord relaxometry, brain diffusion and spinal cord magnetization transfer sequences Biomarkers extracted from optical coherence tomography (OCT) Biological biomarkers (serum neurofilament-light chain (NFL) and Glial Fibrillary Acidic Protein (GFAP))

Official Title
-----------------
Very High Definition Cohort: Assessment of New Prognostic Biomarkers of Disability Worsening in a Multicenter Cohort of MS Patients by Imaging, Optical Coherence Tomography and Biology

Conditions
-----------------
Multiple Sclerosis

Intervention / Treatment
-----------------
* Other: MRI


Participation Criteria
=================
Eligibility Criteria
-----------------
For MS patients: Inclusion Criteria: The patient must be already included in the OFSEP High Definition cohort (NCT03603457). The patient must have given his informed and signed consent for the inclusion in the VHD cohort. The patient must be insured or beneficiary of a health insurance plan. Exclusion Criteria: The patient is under judicial protection. The patient refuses to sign the consent. It is impossible to correctly inform the patient (Inability to understand the study, language problem). The patient has experienced a relapse in the previous 3 months. The patient is pregnant or breast-feeding (MRI contraindicated). Patient with MRI contra-indications (patient with a pacemaker, ferromagnetic vascular clip, infusion pump, neurostimulator, cochlear implants or in whom there is a suspicion of a metallic foreign body). The patient has a severe psychiatric illness The patient has severe chronic alcoholism For healthy subjects: Inclusion Criteria: The healthy subject must be older than 18 years The healthy subject must have given his informed and signed consent for the inclusion in the VHD cohort. The healthy subject must be insured or beneficiary of a health insurance plan. Exclusion Criteria: The healthy subject is under judicial protection. It is impossible to correctly inform the healthy subject (Inability to understand the study, language problem). The healthy subject is pregnant or breast-feeding (MRI contraindicated). The healthy subject has MRI contra-indications (a pacemaker, ferromagnetic vascular clip, infusion pump, neurostimulator, cochlear implants or in whom there is a suspicion of a metallic foreign body). The healthy subject has a history of disease that may affect the central nervous system. The healthy subject has a family history of MS.

Ages Eligible for Study
-----------------
Minimum Age: 18 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
Accepts Healthy Volunteers

Study Plan
=================
How is the study designed?
-----------------

Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Patients with MS<br>250 patients with MRI, OCT and bio sample | Other: MRI<br>* Comparison between groups<br>|
| Healthy subjects<br>50 healthy subjects with MRI | Other: MRI<br>* Comparison between groups<br>|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Global disability progression | Global disability progression will be scored by the Expanded disability score system (EDSS). Disability progression will be defined as an increase in the EDSS of at least 1 point if the baseline EDSS was 5.5 or less, or 0.5 point if the Baseline EDSS was | 2 years | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Composite disability progression score | A composite disability progression score will be defined as an increase in the EDSS score, or an increase in the time to perform the timed 25-foot walk ≥ 20%, or an increase in the time to complete the 9-hole peg test ≥ 20% at 2 years compared to baseline | 2 years | 
| Change in the Symbol Digit Modalities Test score | Change in the Symbol Digit Modalities Test (SDMT) score from baseline to 2-year | 2 years | 
| Change in the American Spinal Cord Injury Association motor sub-score | Change in the American Spinal Cord Injury Association (ASIA) motor sub-score from baseline to 2-year | 2 years | 
| Focal inflammatory activity | Focal inflammatory activity at 2 years will be defined by the occurrence of a clinical relapse and/or MRI activity (new T2 lesion) | 2 years | 
| No evidence of disease activity 3 | No evidence of disease activity (NEDA) 3 at 2 years will be defined as no evidence of disability progression scored by the EDSS, relapse, MRI activity | 2 years | 
| Between-subject, between-center and between-session coefficient of variation of measurements extracted quantitative MRI | Between-subject, between-center and between-session coefficient of variation (in percentage) of measurements extracted from baseline brain and spinal cord quantitative MRI (T1, Myelin water fraction, magnetization transfer ratio, parameters extracted from diffusion imaging) | At inclusion | 
| Number of brain and spinal cord lesion detected using 3D MP2RAGE sequence and the classical OFSEP sequences at baseline and 2 year |  | At inclusion and 2 years | 
| Number of new brain and spinal cord lesion detected at 2 years using 3DMP2RAGE sequence and the classical OFSEP sequences |  | 2 years | 
| Number of detected brain and spinal cord lesions per patient and per expert with and without the automatic tool at baseline and 2 year |  | At baseline and 2 year | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
Prognostic factors, MS progression, MRI, OCT, NFL, GFAP