Breaking the PROMISE: poor association between brain volume loss and clinical disability worsening over 2 years of follow-up in primary progressive multiple sclerosis

Key Points

• The results show a notably weak association between brain volume loss and clinical disability over two years.
• MRI measures indicated an inconsistent relationship with clinical outcomes, raising concerns about relevance.
• Observational analysis across two-year follow-up reveals that lesion burden accumulation does not predict disability worsening.
• Findings highlight the need for better trial endpoints in primary progressive multiple sclerosis, as current measures may not be functionally relevant.