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Chappell M, Sanderson A, Arun T, Green C, Davies H, Tempest M, Watkins D, Arber M, McCool R. Literature review and meta-analysis of natalizumab therapy for the treatment of highly active relapsing remitting multiple sclerosis in the 'suboptimal therapy' patient population. J Neurol Sci 2024; 464:123172. [PMID: 39142083 DOI: 10.1016/j.jns.2024.123172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 07/11/2024] [Accepted: 08/05/2024] [Indexed: 08/16/2024]
Abstract
BACKGROUND Highly active (HA) relapsing remitting multiple sclerosis (RRMS) is associated with frequent relapses and high burden of disease/disability. Natalizumab is licensed for HA RRMS, including rapidly evolving severe (RES) (≥2 relapses in previous year) and sub-optimally treated (SOT) (≥1 relapse in previous year despite treatment) populations. However, there is limited RCT evidence in the SOT subpopulation. OBJECTIVE To review the non-RCT evidence for natalizumab in SOT HA RRMS. METHODS Databases were searched to January 2023 for non-randomised studies of natalizumab in HA RRMS. Studies in patients with ≥1 relapse during previous treatment were eligible for inclusion. Meta-analyses were conducted to compare natalizumab with platform and higher efficacy disease-modifying therapies, with sensitivity analysis restricted to studies of low risk of bias. RESULTS Included comparative studies (n = 16) showed natalizumab had lower relapse rates, disease activity and MRI (radiological) outcomes compared with platform and higher efficacy therapy. Case series (n = 11) showed natalizumab was associated with high rates of freedom from relapse and clinical/radiological disease activity and reductions in annualised relapse rate and disability progression. CONCLUSIONS Literature reviewed indicates that natalizumab is more effective than other included treatments for SOT patients. Findings were consistent with studies in the broad HA RRMS population, suggesting that natalizumab may have similar efficacy for SOT and RES HA RRMS.
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Affiliation(s)
- Mary Chappell
- York Health Economics Consortium, University of York, York, United Kingdom
| | - Alice Sanderson
- York Health Economics Consortium, University of York, York, United Kingdom
| | - Tarunya Arun
- University Hospitals of Coventry and Warwickshire, Department of Neurosciences, University of Warwick, Coventry, United Kingdom
| | - Colin Green
- Biogen Idec Ltd, B5 Foundation Park, Roxborough Way, Maidenhead, United Kingdom.
| | - Heather Davies
- Biogen Idec Ltd, B5 Foundation Park, Roxborough Way, Maidenhead, United Kingdom
| | - Michael Tempest
- Biogen Idec Ltd, B5 Foundation Park, Roxborough Way, Maidenhead, United Kingdom
| | - Deborah Watkins
- York Health Economics Consortium, University of York, York, United Kingdom
| | - Mick Arber
- York Health Economics Consortium, University of York, York, United Kingdom
| | - Rachael McCool
- York Health Economics Consortium, University of York, York, United Kingdom
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2
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How EH, Chin SM, Teo CH, Parhar IS, Soga T. Accelerated biological brain aging in major depressive disorder. Rev Neurosci 2024; 0:revneuro-2024-0025. [PMID: 39002110 DOI: 10.1515/revneuro-2024-0025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 06/26/2024] [Indexed: 07/15/2024]
Abstract
Major depressive disorder (MDD) patients commonly encounter multiple types of functional disabilities, such as social, physical, and role functioning. MDD is related to an accreted risk of brain atrophy, aging-associated brain diseases, and mortality. Based on recently available studies, there are correlations between notable biological brain aging and MDD in adulthood. Despite several clinical and epidemiological studies that associate MDD with aging phenotypes, the underlying mechanisms in the brain remain unknown. The key areas in the study of biological brain aging in MDD are structural brain aging, impairment in functional connectivity, and the impact on cognitive function and age-related disorders. Various measurements have been used to determine the severity of brain aging, such as the brain age gap estimate (BrainAGE) or brain-predicted age difference (BrainPAD). This review summarized the current results of brain imaging data on the similarities between the manifestation of brain structural changes and the age-associated processes in MDD. This review also provided recent evidence of BrainPAD or BrainAGE scores in MDD, brain structural abnormalities, and functional connectivity, which are commonly observed between MDD and age-associated processes. It serves as a basis of current reference for future research on the potential areas of investigation for diagnostic, preventive, and potentially therapeutic purposes for brain aging in MDD.
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Affiliation(s)
- Eng Han How
- 65210 Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia , Jalan Lagoon Selatan, Bandar Sunway, 47500, Selangor, Malaysia
| | - Shar-Maine Chin
- 65210 Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia , Jalan Lagoon Selatan, Bandar Sunway, 47500, Selangor, Malaysia
| | - Chuin Hau Teo
- 65210 Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia , Jalan Lagoon Selatan, Bandar Sunway, 47500, Selangor, Malaysia
| | - Ishwar S Parhar
- Center Initiatives for Training International Researchers (CiTIR), University of Toyama, Gofuku, 930-8555 Toyama, Japan
| | - Tomoko Soga
- 65210 Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia , Jalan Lagoon Selatan, Bandar Sunway, 47500, Selangor, Malaysia
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3
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Fornari Laurindo L, Aparecido Dias J, Cressoni Araújo A, Torres Pomini K, Machado Galhardi C, Rucco Penteado Detregiachi C, Santos de Argollo Haber L, Donizeti Roque D, Dib Bechara M, Vialogo Marques de Castro M, de Souza Bastos Mazuqueli Pereira E, José Tofano R, Jasmin Santos German Borgo I, Maria Barbalho S. Immunological dimensions of neuroinflammation and microglial activation: exploring innovative immunomodulatory approaches to mitigate neuroinflammatory progression. Front Immunol 2024; 14:1305933. [PMID: 38259497 PMCID: PMC10800801 DOI: 10.3389/fimmu.2023.1305933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 12/15/2023] [Indexed: 01/24/2024] Open
Abstract
The increasing life expectancy has led to a higher incidence of age-related neurodegenerative conditions. Within this framework, neuroinflammation emerges as a significant contributing factor. It involves the activation of microglia and astrocytes, leading to the release of pro-inflammatory cytokines and chemokines and the infiltration of peripheral leukocytes into the central nervous system (CNS). These instances result in neuronal damage and neurodegeneration through activated nucleotide-binding domain and leucine-rich repeat containing (NLR) family pyrin domain containing protein 3 (NLRP3) and nuclear factor kappa B (NF-kB) pathways and decreased nuclear factor erythroid 2-related factor 2 (Nrf2) activity. Due to limited effectiveness regarding the inhibition of neuroinflammatory targets using conventional drugs, there is challenging growth in the search for innovative therapies for alleviating neuroinflammation in CNS diseases or even before their onset. Our results indicate that interventions focusing on Interleukin-Driven Immunomodulation, Chemokine (CXC) Receptor Signaling and Expression, Cold Exposure, and Fibrin-Targeted strategies significantly promise to mitigate neuroinflammatory processes. These approaches demonstrate potential anti-neuroinflammatory effects, addressing conditions such as Multiple Sclerosis, Experimental autoimmune encephalomyelitis, Parkinson's Disease, and Alzheimer's Disease. While the findings are promising, immunomodulatory therapies often face limitations due to Immune-Related Adverse Events. Therefore, the conduction of randomized clinical trials in this matter is mandatory, and will pave the way for a promising future in the development of new medicines with specific therapeutic targets.
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Affiliation(s)
- Lucas Fornari Laurindo
- Department of Biochemistry and Pharmacology, School of Medicine, Faculdade de Medicina de Marília (FAMEMA), Marília, São Paulo, Brazil
- Department of Biochemistry and Pharmacology, School of Medicine, Universidade de Marília (UNIMAR), Marília, São Paulo, Brazil
| | - Jefferson Aparecido Dias
- Department of Biochemistry and Pharmacology, School of Medicine, Universidade de Marília (UNIMAR), Marília, São Paulo, Brazil
- Postgraduate Program in Structural and Functional Interactions in Rehabilitation, School of Medicine, Universidade de Marília (UNIMAR), Marília, São Paulo, Brazil
| | - Adriano Cressoni Araújo
- Department of Biochemistry and Pharmacology, School of Medicine, Universidade de Marília (UNIMAR), Marília, São Paulo, Brazil
- Postgraduate Program in Structural and Functional Interactions in Rehabilitation, School of Medicine, Universidade de Marília (UNIMAR), Marília, São Paulo, Brazil
| | - Karina Torres Pomini
- Postgraduate Program in Structural and Functional Interactions in Rehabilitation, School of Medicine, Universidade de Marília (UNIMAR), Marília, São Paulo, Brazil
- Department of Anatomy, School of Medicine, Universidade de Marília (UNIMAR), Marília, São Paulo, Brazil
| | - Cristiano Machado Galhardi
- Department of Biochemistry and Pharmacology, School of Medicine, Universidade de Marília (UNIMAR), Marília, São Paulo, Brazil
| | - Claudia Rucco Penteado Detregiachi
- Postgraduate Program in Structural and Functional Interactions in Rehabilitation, School of Medicine, Universidade de Marília (UNIMAR), Marília, São Paulo, Brazil
| | - Luíza Santos de Argollo Haber
- Department of Biochemistry and Pharmacology, School of Medicine, Universidade de Marília (UNIMAR), Marília, São Paulo, Brazil
| | - Domingos Donizeti Roque
- Department of Biochemistry and Pharmacology, School of Medicine, Universidade de Marília (UNIMAR), Marília, São Paulo, Brazil
- Department of Anatomy, School of Medicine, Universidade de Marília (UNIMAR), Marília, São Paulo, Brazil
| | - Marcelo Dib Bechara
- Department of Biochemistry and Pharmacology, School of Medicine, Universidade de Marília (UNIMAR), Marília, São Paulo, Brazil
| | - Marcela Vialogo Marques de Castro
- Postgraduate Program in Structural and Functional Interactions in Rehabilitation, School of Medicine, Universidade de Marília (UNIMAR), Marília, São Paulo, Brazil
| | - Eliana de Souza Bastos Mazuqueli Pereira
- Postgraduate Program in Structural and Functional Interactions in Rehabilitation, School of Medicine, Universidade de Marília (UNIMAR), Marília, São Paulo, Brazil
| | - Ricardo José Tofano
- Department of Biochemistry and Pharmacology, School of Medicine, Universidade de Marília (UNIMAR), Marília, São Paulo, Brazil
| | - Iris Jasmin Santos German Borgo
- Department of Biological Sciences (Anatomy), School of Dentistry of Bauru, Universidade de São Paulo (FOB-USP), Bauru, São Paulo, Brazil
| | - Sandra Maria Barbalho
- Department of Biochemistry and Pharmacology, School of Medicine, Universidade de Marília (UNIMAR), Marília, São Paulo, Brazil
- Postgraduate Program in Structural and Functional Interactions in Rehabilitation, School of Medicine, Universidade de Marília (UNIMAR), Marília, São Paulo, Brazil
- Department of Biochemistry and Nutrition, School of Food and Technology of Marília (FATEC), Marília, São Paulo, Brazil
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Matthews PM, Gupta D, Mittal D, Bai W, Scalfari A, Pollock KG, Sharma V, Hill N. The association between brain volume loss and disability in multiple sclerosis: A systematic review. Mult Scler Relat Disord 2023; 74:104714. [PMID: 37068369 DOI: 10.1016/j.msard.2023.104714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 03/23/2023] [Accepted: 04/08/2023] [Indexed: 04/19/2023]
Abstract
BACKGROUND Multiple sclerosis (MS) is a chronic, inflammatory, demyelinating, degenerative disease of the central nervous system that affects approximately 2.8 million people worldwide. Compelling evidence from observational studies and clinical trials indicates a strong association between brain volume loss (BVL) and the accumulation of disability in MS. However, the considerable heterogeneity in study designs and methods of assessment of BVL invites questions concerning the generalizability of the reported findings. Therefore, we conducted this systematic review to characterize the relationship between BVL and physical disability in patients with MS. METHODS A systematic literature search of MEDLINE and EMBASE databases was performed supplemented by gray literature searches. The following study designs were included: prospective/retrospective cohort, cross-sectional and case-control. Only English language articles published from 2010 onwards were eligible for final inclusion. There were no restrictions on MS subtype, age, or ethnicity. Of the 1620 citations retrieved by the structured searches, 50 publications met our screening criteria and were included in the final data set. RESULTS Across all BVL measures, there was considerable heterogeneity in studies regarding the underlying study population, the definitions of BVL and image analysis methodologies, the physical disability measure used, the measures of association reported and whether the analysis conducted was univariable or multivariable. A total of 36 primary studies providing data on the association between whole BVL and physical disability in MS collectively suggest that whole brain atrophy is associated with greater physical disability progression in MS patients. Similarly, a total of 15 primary studies providing data on the association between ventricular atrophy and physical disability in MS suggest that ventricular atrophy is associated with greater physical disability progression in MS patients. Along similar lines, the existing evidence based on a total of 13 primary studies suggests that gray matter atrophy is associated with greater physical disability progression in MS patients. Four primary studies suggest that corpus callosum atrophy is associated with greater physical disability progression in MS patients. The majority of the existing evidence (6 primary studies) suggests no association between white matter atrophy and physical disability in MS. It is difficult to assign a relationship between basal ganglia volume loss and physical disability as well as medulla oblongata width and physical disability in MS due to very limited data. CONCLUSION The evidence gathered from this systematic review, although very heterogeneous, suggests that whole brain atrophy is associated with greater physical disability progression in MS patients. Our review can help define future imaging biomarkers for physical disability progression and treatment monitoring in MS.
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Affiliation(s)
- Paul M Matthews
- Department of Brain Sciences and UK Dementia Research Institute at Imperial College London, Burlington Danes Building, Hammersmith Hospital, DuCane Road, London, UK.
| | - Digant Gupta
- Bridge Medical Consulting Limited, 2 Marsault Court, 11 Kew Foot Road, Richmond, London, TW9 2SS, UK
| | - Deepali Mittal
- Bridge Medical Consulting Limited, 2 Marsault Court, 11 Kew Foot Road, Richmond, London, TW9 2SS, UK
| | - Wenjia Bai
- Department of Brain Sciences and UK Dementia Research Institute at Imperial College London, Burlington Danes Building, Hammersmith Hospital, DuCane Road, London, UK; Department of Computing, Imperial College London, William Penny Building, South Kensington Campus, London, UK
| | - Antonio Scalfari
- Imperial College Healthcare Trust, Centre of Neuroscience, Department of Medicine, Charing Cross Hospital, Fulham Palace Rd, London W6 8RF, UK
| | - Kevin G Pollock
- Bristol-Myers Squibb, Uxbridge Business Park, Sanderson Road, Uxbridge, UB8 1DH, UK
| | - Vishal Sharma
- Bristol-Myers Squibb, Uxbridge Business Park, Sanderson Road, Uxbridge, UB8 1DH, UK
| | - Nathan Hill
- Bristol-Myers Squibb, Uxbridge Business Park, Sanderson Road, Uxbridge, UB8 1DH, UK
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5
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Grahl S, Bussas M, Wiestler B, Eichinger P, Gaser C, Kirschke J, Zimmer C, Berthele A, Hemmer B, Mühlau M. Differential Effects of Fingolimod and Natalizumab on Magnetic Resonance Imaging Measures in Relapsing-Remitting Multiple Sclerosis. Neurotherapeutics 2021; 18:2589-2597. [PMID: 34561843 PMCID: PMC8804113 DOI: 10.1007/s13311-021-01118-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2021] [Indexed: 11/24/2022] Open
Abstract
Fingolimod and natalizumab are approved disease-modifying drugs in relapsing-remitting multiple sclerosis (RRMS). The two drugs have different modes of action and may therefore influence different aspects of MS-related tissue damage. In this retrospective cohort study, we longitudinally compared patients treated with fingolimod and patients treated with natalizumab by measures based on structural magnetic resonance imaging (MRI). We included patients with RRMS given that two standardized MRI scans under the same drug were available with an interval of at least 6 months both from therapy start to baseline scan and from baseline scan to follow-up scan. After matching for age, baseline and follow-up scans from 93 patients (fingolimod, 48; natalizumab, 45) were investigated. Mean follow-up time was 1.9 years. We determined the number of new white matter lesions as well as thalamic, cortical, and whole-brain atrophy. After scaling for time of the interscan interval, measures were analyzed by group comparisons and, to account for demographic and clinical characteristics, by multiple regression models and a binary logistic regression model. Compared to natalizumab, fingolimod treatment went along with more new white matter lesions (median [interquartile range, IQR] 0.0 [0.0; 0.7] vs. 0.0 [0.0; 0.0] /year; p < 0.01) whereas whole-brain atrophy was lower (median [IQR] 0.2 [0.0; 0.5] vs. 0.5 [0.2; 1.0] %/year; p = 0.01). These significant differences were confirmed by multiple regression models and the binary logistic regression model. In conclusion, our observation is compatible with stronger neuroprotective properties of fingolimod compared to natalizumab.
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Affiliation(s)
- S Grahl
- Department of Neurology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
- TUM Neuroimaging, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - M Bussas
- Department of Neurology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
- TUM Neuroimaging, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - B Wiestler
- Department of Neuroradiology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - P Eichinger
- Department of Neuroradiology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - C Gaser
- Department of Psychiatry and Department of Neurology, Jena University Hospital, Jena, Germany
| | - J Kirschke
- Department of Neuroradiology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - C Zimmer
- Department of Neuroradiology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - A Berthele
- Department of Neurology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - B Hemmer
- Department of Neurology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Feodor-Lynen-Str. 17, 81377, Munich, Germany
| | - M Mühlau
- Department of Neurology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
- TUM Neuroimaging, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
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6
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Alvarez E, Nair KV, Hoyt BD, Seale RA, Sillau S, Miravalle A, Engebretson E, Schurr B, Corboy JR, Vollmer TL, Honce JM. Brain atrophy rates in patients with multiple sclerosis on long term natalizumab resembles healthy controls. Mult Scler Relat Disord 2021; 55:103170. [PMID: 34364034 DOI: 10.1016/j.msard.2021.103170] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 06/28/2021] [Accepted: 07/22/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Clinically stable multiple sclerosis (MS) patients often have negligible inflammatory MRI changes. Brain atrophy may provide insight into subclinical disease progression. The objective was to compare brain atrophy rates in stable patients on long term natalizumab treatment vs. age and gender matched healthy non-MS controls (HC) prospectively over two-years examining brain volume, cognition, and patient reported outcomes (PROs). METHODS MS patients treated with natalizumab for a minimum of 2 years, age 18-60 were recruited and compared with age- and gender-matched healthy controls (HC). Both groups were followed prospectively to obtain two years of consecutive magnetic resonance imaging, clinical and PRO data. Baseline normalized brain volume (NBV), yearly T2 lesion volume (T2LV), and percent brain volume change (PBVC) were measured using SIENAX, JIM 6.0, and SIENA respectively. Neuropsychological tests from the MACFIMS battery were selected to optimize assessments for impairments in the domains of information processing speed and memory. Patient reported outcomes (PROs) for domains of physical, mental and social quality of life were evaluated using the NeuroQol short forms. RESULTS Forty-eight natalizumab and 62 HC completed all study visits. At baseline, unadjusted mean NBV (natalizumab=1508.80cm (Popescu et al., 2013) vs. HC=1539.23cm (Popescu et al., 2013); p=0.033) and median baseline T2LV (natalizumab=1724.62mm (Popescu et al., 2013) vs. HC=44.20mm (Popescu et al., 2013); p=<0.0001) were different. The mean PBVC at year 2, adjusted for gender and baseline age was -0.57% (CI: 0.7620, -0.3716) for natalizumab and -0.50% (-0.7208, -0.2831) for HC, but the difference between groups was not statistically significant (0.073%; p=0.62). Over the 2-year period, HC demonstrated mild improvements in some cognitive tests vs. natalizumab subjects. However, PROs were similar between the two groups. CONCLUSION Stable MS patients on natalizumab have similar brain volume loss as people who do not have MS, suggesting normalization of brain atrophy.
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Affiliation(s)
- Enrique Alvarez
- Department of Neurology, Rocky Mountain Multiple Sclerosis Center at the University of Colorado, 1635 Aurora Court, Aurora, CO 80045 USA
| | - Kavita V Nair
- Department of Neurology, Rocky Mountain Multiple Sclerosis Center at the University of Colorado, 1635 Aurora Court, Aurora, CO 80045 USA; Department of Clinical Pharmacy, University of Colorado, 12850 East Montview Boulevard, Aurora, CO 80045 USA
| | - Brian D Hoyt
- Department of Neurosurgery, University of Colorado, 12631 East 17th Avenue, Aurora, CO 80045 USA
| | - Rebecca A Seale
- Department of Neurology, Rocky Mountain Multiple Sclerosis Center at the University of Colorado, 1635 Aurora Court, Aurora, CO 80045 USA
| | - Stefan Sillau
- Department of Neurology, Rocky Mountain Multiple Sclerosis Center at the University of Colorado, 1635 Aurora Court, Aurora, CO 80045 USA
| | - Augusto Miravalle
- Advanced Neurology, 2121 E Harmony Rd Ste #180, Fort Collins, CO 80528 USA
| | - Eric Engebretson
- Department of Neurology, Rocky Mountain Multiple Sclerosis Center at the University of Colorado, 1635 Aurora Court, Aurora, CO 80045 USA
| | - Brittany Schurr
- Department of Neurology, Rocky Mountain Multiple Sclerosis Center at the University of Colorado, 1635 Aurora Court, Aurora, CO 80045 USA
| | - John R Corboy
- Department of Neurology, Rocky Mountain Multiple Sclerosis Center at the University of Colorado, 1635 Aurora Court, Aurora, CO 80045 USA
| | - Timothy L Vollmer
- Department of Neurology, Rocky Mountain Multiple Sclerosis Center at the University of Colorado, 1635 Aurora Court, Aurora, CO 80045 USA
| | - Justin M Honce
- Department of Radiology, University of Colorado Hospital, 12401 East 17th Avenue, Aurora, CO 80045 USA.
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7
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Honce JM, Nair KV, Hoyt BD, Seale RA, Sillau S, Engebretson E, Schurr B, Corboy JR, Vollmer TL, Alvarez E. Brain Atrophy Rates for Stable Multiple Sclerosis Patients on Long-Term Fingolimod versus Glatiramer Acetate. Front Neurol 2020; 11:1045. [PMID: 33071934 PMCID: PMC7538802 DOI: 10.3389/fneur.2020.01045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 08/10/2020] [Indexed: 12/31/2022] Open
Abstract
Background: Clinically stable multiple sclerosis (MS) patients on long-term therapy often have negligible acute inflammation on MRI. Brain atrophy may provide insight into subclinical disease progression in such populations. Objective: This study aims to compare brain atrophy for age- and gender-matched MS patients treated for >2 years with fingolimod (FTY) or glatiramer acetate (GA), examining brain volume, cognition, and patient-reported outcomes (PROs). Methods: Stable relapsing-MS patients, age 18-60, on FTY or GA for >2 years were followed up for 2 years. MRI brain and lesion volumes, cognitive measures, and PROs were collected at baseline and annually. Results: Forty-four FTY and forty-three GA patients completed baseline and year 2 visits. No differences in age, gender, or education were observed. Median EDSS was 2.0GA and 2.5FTY (p = 0.22). Treatment duration was longer for GA, 6.50GA vs. 3.73FTY years (p < 0.001). Baseline geometric mean T2LV were different, GA = 1,009.29 cm3 vs. FTY = 2,404.67 cm3 (p = 0.0071). Baseline brain volumes were similar, GA = 1,508 cm3 vs. FTY = 1,489 cm3 (p = 0.2381). Annualized atrophy rates, adjusted for baseline and at mean baseline value, were GA = -0.2775% vs. FTY = -0.2967% (p = 0.7979). No differences in cognitive measures or PROs were observed. Conclusions: Stable MS patients on long-term treatment with FTY and GA have similar brain volume loss rates. Differences in baseline disease severity may suggest patients with more aggressive disease treated with FTY may achieve similar brain volume loss rates as patients with milder baseline disease on GA.
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Affiliation(s)
- Justin M Honce
- Department of Radiology, University of Colorado Hospital, Aurora, CO, United States
| | - Kavita V Nair
- Department of Clinical Pharmacy, University of Colorado, Aurora, CO, United States.,Department of Neurology, University of Colorado and Rocky Mountain Multiple Sclerosis Center at the University of Colorado, Aurora, CO, United States
| | - Brian D Hoyt
- Department of Neurology, University of Colorado and Rocky Mountain Multiple Sclerosis Center at the University of Colorado, Aurora, CO, United States.,Department of Neurosurgery, University of Colorado, Aurora, CO, United States
| | - Rebecca A Seale
- Department of Neurology, University of Colorado and Rocky Mountain Multiple Sclerosis Center at the University of Colorado, Aurora, CO, United States
| | - Stefan Sillau
- Department of Neurology, University of Colorado and Rocky Mountain Multiple Sclerosis Center at the University of Colorado, Aurora, CO, United States
| | - Eric Engebretson
- Department of Neurology, University of Colorado and Rocky Mountain Multiple Sclerosis Center at the University of Colorado, Aurora, CO, United States
| | - Brittany Schurr
- Department of Neurology, University of Colorado and Rocky Mountain Multiple Sclerosis Center at the University of Colorado, Aurora, CO, United States
| | - John R Corboy
- Department of Neurology, University of Colorado and Rocky Mountain Multiple Sclerosis Center at the University of Colorado, Aurora, CO, United States
| | - Timothy L Vollmer
- Department of Neurology, University of Colorado and Rocky Mountain Multiple Sclerosis Center at the University of Colorado, Aurora, CO, United States
| | - Enrique Alvarez
- Department of Neurology, University of Colorado and Rocky Mountain Multiple Sclerosis Center at the University of Colorado, Aurora, CO, United States
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8
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Koskimäki F, Bernard J, Yong J, Arndt N, Carroll T, Lee SK, Reder AT, Javed A. Gray matter atrophy in multiple sclerosis despite clinical and lesion stability during natalizumab treatment. PLoS One 2018; 13:e0209326. [PMID: 30576361 PMCID: PMC6303064 DOI: 10.1371/journal.pone.0209326] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 12/04/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Brain volume loss is an important surrogate marker for assessing disability in MS; however, contribution of gray and white matter to the whole brain volume loss needs further examination in the context of specific MS treatment. OBJECTIVES To examine whole and segmented gray, white, thalamic, and corpus callosum volume loss in stable patients receiving natalizumab for 2-5 years. METHODS This was a retrospective study of 20 patients undergoing treatment with natalizumab for 24-68 months. Whole brain volume loss was determined with SIENA. Gray and white matter segmentation was done using FAST. Thalamic and corpus callosum volumes were determined using Freesurfer. T1 relaxation values of chronic hypointense lesions (black holes) were determined using a quantitative, in-house developed method to assess lesion evolution. RESULTS Over a mean of 36.6 months, median percent brain volume change (PBVC) was -2.0% (IQR 0.99-2.99). There was decline in gray (p = 0.001) but not white matter (p = 0.6), and thalamic (p = 0.01) but not corpus callosum volume (p = 0.09). Gray matter loss correlated with PBVC (Spearman's r = 0.64, p = 0.003) but not white matter (Spearman's r = 0.42, p = 0.07). Age significantly influenced whole brain volume loss (p = 0.010, multivariate regression), but disease duration and baseline T2 lesion volume did not. There was no change in T1 relaxation values of lesions or T2 lesion volume over time. All patients remained clinically stable. CONCLUSIONS These results demonstrate that brain volume loss in MS is primarily driven by gray matter changes and may be independent of clinically effective treatment.
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Affiliation(s)
- Fredrika Koskimäki
- Division of Clinical Neurosciences, Turku University Hospital and University of Turku, Turku, Finland
| | - Jacqueline Bernard
- Department of Neurology, Oregon Health Science University, Portland, Oregon, United States of America
| | - Jeong Yong
- Northwestern University, Biomedical Engineering, Chicago, Illinois, United States of America
| | - Nancy Arndt
- Department of Neurology, The University of Chicago, Chicago, Illinois, United States of America
| | - Timothy Carroll
- Department of Radiology, The University of Chicago, Chicago, Illinois, United States of America
| | - Seon-Kyu Lee
- Department of Radiology, The University of Chicago, Chicago, Illinois, United States of America
| | - Anthony T. Reder
- Department of Neurology, The University of Chicago, Chicago, Illinois, United States of America
| | - Adil Javed
- Department of Neurology, The University of Chicago, Chicago, Illinois, United States of America
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9
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Eisele P, Szabo K, Ebert A, Platten M, Gass A. Brain Atrophy in Natalizumab-treated Patients with Multiple Sclerosis: A 5-year Retrospective Study. J Neuroimaging 2018; 29:190-192. [DOI: 10.1111/jon.12586] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 11/16/2018] [Accepted: 11/17/2018] [Indexed: 01/03/2023] Open
Affiliation(s)
- Philipp Eisele
- Department of Neurology; Universitätsmedizin Mannheim; University of Heidelberg; Mannheim Baden-Württemberg Germany
| | - Kristina Szabo
- Department of Neurology; Universitätsmedizin Mannheim; University of Heidelberg; Mannheim Baden-Württemberg Germany
| | - Anne Ebert
- Department of Neurology; Universitätsmedizin Mannheim; University of Heidelberg; Mannheim Baden-Württemberg Germany
| | - Michael Platten
- Department of Neurology; Universitätsmedizin Mannheim; University of Heidelberg; Mannheim Baden-Württemberg Germany
| | - Achim Gass
- Department of Neurology; Universitätsmedizin Mannheim; University of Heidelberg; Mannheim Baden-Württemberg Germany
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10
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Puthenparampil M, Cazzola C, Zywicki S, Federle L, Stropparo E, Anglani M, Rinaldi F, Perini P, Gallo P. NEDA-3 status including cortical lesions in the comparative evaluation of natalizumab versus fingolimod efficacy in multiple sclerosis. Ther Adv Neurol Disord 2018; 11:1756286418805713. [PMID: 30386435 PMCID: PMC6204617 DOI: 10.1177/1756286418805713] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 09/07/2018] [Indexed: 11/23/2022] Open
Abstract
Background: Cortical lesions (CLs) are typical of multiple sclerosis (MS) and have been recently incorporated in MS diagnostic criteria. Thus, the ‘no evidence of disease activity’ (NEDA) definition should now include CLs. The aim of this study was to evaluate the NEDA3 + CL status in natalizumab- or fingolimod-treated relapsing remitting MS (RMS) patients. Methods: Natalizumab- or fingolimod-treated RMS patients were enrolled in a 2-year longitudinal study based on clinical and magnetic resonance imaging (MRI) evaluations performed respectively biannually and annually. CLs were detected by double inversion recovery. The NEDA3 + CL condition was evaluated at baseline (T0) and at the end of the first (T1) and second (T2) year. Results: Of the 137 RMS patients included in the study, 86 were propensity-matched. At T2, the annualized relapse rate was lower on natalizumab (p = 0.021), but the effect on white matter lesions (p = 0.29) and the proportion of NEDA-3 patients (p = 0.14) were similar in the two treatment arms. At T2, 11.6% natalizumab- and 62.8% fingolimod-treated patients had new CLs (p < 0.001) and a higher proportion of natalizumab-treated patients (55.8% versus 11.6%, p < 0.001) achieved the NEDA3 + CL status (hazard ratio 5.2, p < 0.001). Conclusion: The incorporation of CLs in the NEDA-3 definition highlighted the higher efficacy of natalizumab versus fingolimod in suppressing disease activity in RMS patients.
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Affiliation(s)
- Marco Puthenparampil
- Multiple Sclerosis Centre, Department of Neuroscience DNS, Univeristà Degli Studi di Padova, Via Giustinaini 2, 35128, Padova, Italy
| | - Chiara Cazzola
- Multiple Sclerosis Centre, Department of Neuroscience DNS, University of Padua, Padua, Italy
| | - Sofia Zywicki
- Multiple Sclerosis Centre, Department of Neuroscience DNS, University of Padua, Padua, Italy
| | - Lisa Federle
- Multiple Sclerosis Centre, Ospedale San Bortolo, ULSS8 Berica, Vicenza, Italy
| | - Erica Stropparo
- Multiple Sclerosis Centre, Department of Neuroscience DNS, University of Padua, Padua, Italy
| | | | | | - Paola Perini
- Neurology Clinic, University Hospital of Padua, Padova, Italy
| | - Paolo Gallo
- Multiple Sclerosis Centre, Department of Neuroscience DNS, University of Padua, Padua, Italy
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11
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Zivadinov R, Medin J, Khan N, Korn JR, Bergsland N, Dwyer MG, Chitnis T, Naismith RT, Alvarez E, Kinkel P, Cohan S, Hunter SF, Silva D, Weinstock-Guttman B. Fingolimod's Impact on MRI Brain Volume Measures in Multiple Sclerosis: Results from MS-MRIUS. J Neuroimaging 2018; 28:399-405. [DOI: 10.1111/jon.12518] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 04/13/2018] [Accepted: 04/14/2018] [Indexed: 12/16/2022] Open
Affiliation(s)
- Robert Zivadinov
- Buffalo Neuroimaging Analysis Center, Buffalo, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences; University at Buffalo, The State University of New York; Buffalo NY
- Center for Biomedical Imaging, Clinical Translational Science Institute; University at Buffalo, The State University of New York; Buffalo NY
| | | | | | | | - Niels Bergsland
- Buffalo Neuroimaging Analysis Center, Buffalo, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences; University at Buffalo, The State University of New York; Buffalo NY
| | - Michael G. Dwyer
- Buffalo Neuroimaging Analysis Center, Buffalo, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences; University at Buffalo, The State University of New York; Buffalo NY
| | - Tanuja Chitnis
- Partners MS Center, Brigham and Women's Hospital; Boston MA
| | | | - Enrique Alvarez
- Department of Neurology; University of Colorado School of Medicine; CO
| | | | | | | | | | - Bianca Weinstock-Guttman
- Jacobs Multiple Sclerosis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences; University at Buffalo, The State University of New York; Buffalo NY
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12
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Warntjes JBM, Tisell A, Håkansson I, Lundberg P, Ernerudh J. Improved Precision of Automatic Brain Volume Measurements in Patients with Clinically Isolated Syndrome and Multiple Sclerosis Using Edema Correction. AJNR Am J Neuroradiol 2018; 39:296-302. [PMID: 29242365 DOI: 10.3174/ajnr.a5476] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 10/08/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The presence of edema will result in increased brain volume, which may obscure progressing brain atrophy. Similarly, treatment-induced edema reduction may appear as accelerated brain tissue loss (pseudoatrophy). The purpose of this study was to correlate brain tissue properties to brain volume, to investigate the possibilities for edema correction and the resulting improvement of the precision of automated brain volume measurements. MATERIALS AND METHODS A group of 38 patients with clinically isolated syndrome or newly diagnosed MS were imaged at inclusion and after 1, 2, and 4 years using an MR quantification sequence. Brain volume, relaxation rates (R1 and R2), and proton density were measured by automated software. RESULTS The reduction of normalized brain volume with time after inclusion was 0.273%/year. The mean SDs were 0.508%, 0.526%, 0.454%, and 0.687% at baseline and 1, 2, and 4 years. Linear regression of the relative change of normalized brain volume and the relative change of R1, R2, and proton density showed slopes of -0.198 (P < .001), 0.156 (P = .04), and 0.488 (P < .001), respectively. After we applied the measured proton density as a correction factor, the mean SDs decreased to 24.2%, 4.8%, 33.3%, and 17.4%, respectively. The observed atrophy rate reduced from 0.273%/year to 0.238%/year. CONCLUSIONS Correlations between volume and R1, R2, and proton density were observed in the brain, suggesting that a change of brain tissue properties can affect brain volume. Correction using these parameters decreased the variation of brain volume measurements and may have reduced the effect of pseudoatrophy.
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Affiliation(s)
- J B M Warntjes
- From the Center for Medical Image Science and Visualization (J.B.M.W., A.T., P.L.)
- Division of Cardiovascular Medicine (J.B.M.W.)
- SyntheticMR AB (J.B.M.W.), Linköping, Sweden
| | - A Tisell
- From the Center for Medical Image Science and Visualization (J.B.M.W., A.T., P.L.)
- Radiation Physics (A.T., P.L.), Department of Medical and Health Sciences
| | - I Håkansson
- Department of Neurology (I.H.), Department of Clinical and Experimental Medicine
| | - P Lundberg
- From the Center for Medical Image Science and Visualization (J.B.M.W., A.T., P.L.)
- Radiation Physics (A.T., P.L.), Department of Medical and Health Sciences
| | - J Ernerudh
- Department of Clinical Immunology and Transfusion Medicine (J.E.)
- Department of Clinical and Experimental Medicine (J.E.), Linköping University, Sweden
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13
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Favaretto A, Lazzarotto A, Margoni M, Poggiali D, Gallo P. Effects of disease modifying therapies on brain and grey matter atrophy in relapsing remitting multiple sclerosis. ACTA ACUST UNITED AC 2018. [DOI: 10.1186/s40893-017-0033-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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14
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McNamara C, Sugrue G, Murray B, MacMahon PJ. Current and Emerging Therapies in Multiple Sclerosis: Implications for the Radiologist, Part 2-Surveillance for Treatment Complications and Disease Progression. AJNR Am J Neuroradiol 2017; 38:1672-1680. [PMID: 28428206 DOI: 10.3174/ajnr.a5148] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
An understanding of the new generation of MS drugs in conjunction with the key role MR imaging plays in the detection of disease progression, opportunistic infections, and drug-related adverse effects is of vital importance to the neuroradiologist. Part 1 of this review outlined the current treatment options available for MS and examined the mechanisms of action of the various medications. It also covered specific complications associated with each form of therapy. Part 2, in turn deals with the subject of pharmacovigilance and the optimal frequency of MRI monitoring for each individual patient, depending on his or her unique risk profile. Special attention is given to the diagnosing of progressive multifocal leukoencephalopathy in patients treated with natalizumab as this is a key area in which neuroradiologists can contribute to improved patient outcomes. This article also outlines the aims of treatment and reviews the possibility of "no evidence of disease activity" becoming a treatment goal with the availability of more effective therapies. Potential future areas and technologies including image subtraction, brain volume measurement and advanced imaging techniques such as double inversion recovery are also reviewed. It is anticipated that such advancements in this rapidly developing field will improve the accuracy of monitoring an individual patient's response to treatment.
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Affiliation(s)
- C McNamara
- From the Departments of Radiology (C.M., G.S., P.J.M.)
| | - G Sugrue
- From the Departments of Radiology (C.M., G.S., P.J.M.)
| | - B Murray
- Neurology (B.M.), Mater Misericordiae University Hospital, Dublin, Ireland
| | - P J MacMahon
- From the Departments of Radiology (C.M., G.S., P.J.M.)
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15
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Kanodia AK. Relevance of biomarkers in disease progression in multiple sclerosis. Eur J Neurol 2017; 24:7-8. [DOI: 10.1111/ene.13170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- A. K. Kanodia
- Department of Radiology; Ninewells Hospital Dundee; Dundee UK
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16
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Mellergård J, Tisell A, Blystad I, Grönqvist A, Blennow K, Olsson B, Dahle C, Vrethem M, Lundberg P, Ernerudh J. Cerebrospinal fluid levels of neurofilament and tau correlate with brain atrophy in natalizumab-treated multiple sclerosis. Eur J Neurol 2016; 24:112-121. [PMID: 27699930 DOI: 10.1111/ene.13162] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Accepted: 08/09/2016] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND PURPOSE Brain atrophy is related to clinical deterioration in multiple sclerosis (MS) but its association with intrathecal markers of inflammation or neurodegeneration is unclear. Our aim was to investigate whether cerebrospinal fluid (CSF) markers of inflammation or neurodegeneration are associated with brain volume change in natalizumab-treated MS and whether this change is reflected in non-lesional white matter metabolites. METHODS About 25 patients with natalizumab-treated MS were followed for 3 years with assessment of percentage brain volume change (PBVC) and absolute quantification of metabolites with proton magnetic resonance spectroscopy (1 H MRS). Analyses of inflammatory [interleukin 1β (IL-1β), IL-6, C-X-C motif chemokine 8 (CXCL8), CXCL10, CXCL11, C-C motif chemokine 22] and neurodegenerative [neurofilament light protein (NFL), glial fibrillary acidic protein, myelin basic protein, tau proteins] markers were done at baseline and 1-year follow-up. RESULTS The mean decline in PBVC was 3% at the 3-year follow-up, although mean 1 H MRS metabolite levels in non-lesional white matter were unchanged. CSF levels of NFL and tau at baseline correlated negatively with PBVC over 3 years (r = -0.564, P = 0.012, and r = -0.592, P = 0.010, respectively). CONCLUSIONS A significant 3-year whole-brain atrophy was not reflected in mean metabolite change of non-lesional white matter. In addition, our results suggest that CSF levels of NFL and tau correlate with brain atrophy development and may be used for evaluating treatment response in inflammatory active MS.
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Affiliation(s)
- J Mellergård
- Department of Neurology and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - A Tisell
- Department of Radiation Physics and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.,Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - I Blystad
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden.,Department of Radiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - A Grönqvist
- Department of Radiation Physics and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - K Blennow
- Clinical Neurochemistry Laboratory, Institution of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden
| | - B Olsson
- Clinical Neurochemistry Laboratory, Institution of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden
| | - C Dahle
- Department of Clinical Immunology and Transfusion Medicine and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - M Vrethem
- Department of Neurology and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.,Department of Clinical Neurophysiology and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - P Lundberg
- Department of Radiation Physics and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.,Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden.,Department of Radiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - J Ernerudh
- Department of Clinical Immunology and Transfusion Medicine and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
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17
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Gandhi S, Jakimovski D, Ahmed R, Hojnacki D, Kolb C, Weinstock-Guttman B, Zivadinov R. Use of natalizumab in multiple sclerosis: current perspectives. Expert Opin Biol Ther 2016; 16:1151-62. [DOI: 10.1080/14712598.2016.1213810] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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18
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Zivadinov R, Hojnacki D, Bergsland N, Kennedy C, Hagemeier J, Melia R, Ramasamy DP, Durfee J, Carl E, Dwyer MG, Weinstock-Guttman B. Effect of natalizumab on brain atrophy and disability progression in multiple sclerosis patients over 5 years. Eur J Neurol 2016; 23:1101-9. [DOI: 10.1111/ene.12992] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 02/02/2016] [Indexed: 01/21/2023]
Affiliation(s)
- R. Zivadinov
- Department of Neurology; Buffalo Neuroimaging Analysis Center; University at Buffalo; State University of New York; Buffalo NY USA
- MR Imaging Clinical Translational Research Center; School of Medicine and Biomedical Sciences; University at Buffalo; State University of New York; Buffalo NY USA
| | - D. Hojnacki
- Jacobs MS Center; Department of Neurology; University at Buffalo; State University of New York; Buffalo NY USA
| | - N. Bergsland
- Department of Neurology; Buffalo Neuroimaging Analysis Center; University at Buffalo; State University of New York; Buffalo NY USA
- Magnetic Resonance Laboratory; IRCCS Don Gnocchi Foundation; Milan Italy
| | - C. Kennedy
- Department of Neurology; Buffalo Neuroimaging Analysis Center; University at Buffalo; State University of New York; Buffalo NY USA
| | - J. Hagemeier
- Department of Neurology; Buffalo Neuroimaging Analysis Center; University at Buffalo; State University of New York; Buffalo NY USA
| | - R. Melia
- Department of Neurology; Buffalo Neuroimaging Analysis Center; University at Buffalo; State University of New York; Buffalo NY USA
| | - D. P. Ramasamy
- Department of Neurology; Buffalo Neuroimaging Analysis Center; University at Buffalo; State University of New York; Buffalo NY USA
| | - J. Durfee
- Department of Neurology; Buffalo Neuroimaging Analysis Center; University at Buffalo; State University of New York; Buffalo NY USA
| | - E. Carl
- Department of Neurology; Buffalo Neuroimaging Analysis Center; University at Buffalo; State University of New York; Buffalo NY USA
| | - M. G. Dwyer
- Department of Neurology; Buffalo Neuroimaging Analysis Center; University at Buffalo; State University of New York; Buffalo NY USA
| | - B. Weinstock-Guttman
- Jacobs MS Center; Department of Neurology; University at Buffalo; State University of New York; Buffalo NY USA
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19
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Wiebenga OT, Schoonheim MM, Hulst HE, Nagtegaal GJA, Strijbis EMM, Steenwijk MD, Polman CH, Pouwels PJW, Barkhof F, Geurts JJG. White Matter Diffusion Changes during the First Year of Natalizumab Treatment in Relapsing-Remitting Multiple Sclerosis. AJNR Am J Neuroradiol 2016; 37:1030-7. [PMID: 26965463 DOI: 10.3174/ajnr.a4690] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 11/12/2015] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND PURPOSE Natalizumab treatment strongly affects relapsing-remitting multiple sclerosis, possibly by restraining white matter damage. This study investigated changes in white matter diffusivity in patients with relapsing-remitting multiple sclerosis during their first year of natalizumab treatment by using diffusion tensor imaging. MATERIALS AND METHODS The study included patients with relapsing-remitting multiple sclerosis initiating natalizumab at baseline (n = 22), patients with relapsing-remitting multiple sclerosis continuing interferon-β or glatiramer acetate (n = 17), and healthy controls (n = 12). Diffusion tensor imaging parameters were analyzed at baseline and month 12. We measured the extent and severity of white matter damage with diffusion tensor imaging parameters such as fractional anisotropy, comparing the patient groups with healthy controls at both time points. RESULTS The extent and severity of white matter damage were reduced significantly in the natalizumab group with time (fractional anisotropy-based extent, 56.8% to 47.2%; severity, z = -0.67 to -0.59; P = .02); this reduction was not observed in the interferon-β/glatiramer acetate group (extent, 41.4% to 39.1%, and severity, z = -0.64 to -0.67; P = .94). Cognitive performance did not change with time in the patient groups but did correlate with the severity of damage (r = 0.53, P = < .001). CONCLUSIONS In patients with relapsing-remitting multiple sclerosis starting natalizumab treatment, the extent and severity of white matter damage were reduced significantly in the first year of treatment. These findings may aid in explaining the large observed clinical effect of natalizumab in relapsing-remitting multiple sclerosis.
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Affiliation(s)
- O T Wiebenga
- From the Departments of Radiology and Nuclear Medicine (O.T.W., G.J.A.N., M.D.S., F.B.) Anatomy and Neurosciences (O.T.W., M.M.S., H.E.H., G.J.A.N., J.J.G.G.)
| | - M M Schoonheim
- Anatomy and Neurosciences (O.T.W., M.M.S., H.E.H., G.J.A.N., J.J.G.G.)
| | - H E Hulst
- Anatomy and Neurosciences (O.T.W., M.M.S., H.E.H., G.J.A.N., J.J.G.G.)
| | - G J A Nagtegaal
- From the Departments of Radiology and Nuclear Medicine (O.T.W., G.J.A.N., M.D.S., F.B.) Anatomy and Neurosciences (O.T.W., M.M.S., H.E.H., G.J.A.N., J.J.G.G.)
| | | | - M D Steenwijk
- From the Departments of Radiology and Nuclear Medicine (O.T.W., G.J.A.N., M.D.S., F.B.)
| | | | - P J W Pouwels
- Physics and Medical Technology (P.J.W.P.), Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, the Netherlands
| | - F Barkhof
- From the Departments of Radiology and Nuclear Medicine (O.T.W., G.J.A.N., M.D.S., F.B.)
| | - J J G Geurts
- Anatomy and Neurosciences (O.T.W., M.M.S., H.E.H., G.J.A.N., J.J.G.G.)
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20
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De Stefano N, Stromillo ML, Giorgio A, Bartolozzi ML, Battaglini M, Baldini M, Portaccio E, Amato MP, Sormani MP. Establishing pathological cut-offs of brain atrophy rates in multiple sclerosis. J Neurol Neurosurg Psychiatry 2016; 87:93-9. [PMID: 25904813 PMCID: PMC4717444 DOI: 10.1136/jnnp-2014-309903] [Citation(s) in RCA: 96] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 01/11/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess whether it is feasible to establish specific cut-off values able to discriminate 'physiological' or 'pathological' brain volume rates in patients with multiple sclerosis (MS). METHODS The study was based on the analysis of longitudinal MRI data sets of patients with MS (n=206, 87% relapsing-remitting, 7% secondary progressive and 6% primary progressive) and healthy controls (HC; n=35). Brain atrophy rates were computed over a mean follow-up of 7.5 years (range 1-12) for patients with MS and 6.3 years (range 1-12.5) for HC with the SIENA software and expressed as annualised per cent brain volume change (PBVC/y). A weighted (on the follow-up length) receiver operating characteristic analysis and the area under the curve (AUC) were used for statistics. RESULTS The weighted PBVC/y was -0.51±0.27% in patients with MS and -0.27±0.15% in HC (p<0.0001). There was a significant age-related difference in PBVC/y between HC older and younger than 35 years of age (p=0.02), but not in patients with MS (p=0.8). The cut-off of PBVC/y, as measured by SIENA that could maximise the accuracy in discriminating patients with MS from HC, was -0.37%, with 67% sensitivity and 80% specificity. According to the observed distribution, values of PBVC/y as measured by SIENA that could define a pathological range were above -0.52% with 95% specificity, above -0.46% with 90% specificity and above -0.40% with 80% specificity. CONCLUSIONS Our evidence-based criteria provide values able to discriminate the presence or absence of 'pathological' brain volume loss in MS with high specificity. Such results could be of great value in a clinical setting, particularly in assessing treatment efficacy in MS.
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Affiliation(s)
- Nicola De Stefano
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | | | - Antonio Giorgio
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | | | - Marco Battaglini
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | | | - Emilio Portaccio
- Department of Neurology, University of Florence, Florence, Italy
| | - Maria Pia Amato
- Department of Neurology, University of Florence, Florence, Italy
| | - Maria Pia Sormani
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
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21
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Mattioli F, Stampatori C, Bellomi F, Scarpazza C, Capra R. Natalizumab Significantly Improves Cognitive Impairment over Three Years in MS: Pattern of Disability Progression and Preliminary MRI Findings. PLoS One 2015; 10:e0131803. [PMID: 26148120 PMCID: PMC4492934 DOI: 10.1371/journal.pone.0131803] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 06/07/2015] [Indexed: 11/18/2022] Open
Abstract
Previous studies reported that Multiple Sclerosis (MS) patients treated with natalizumab for one or two years exhibit a significant reduction in relapse rate and in cognitive impairment, but the long term effects on cognitive performance are unknown. This study aimed to evaluate the effects of natalizumab on cognitive impairment in a cohort of 24 consecutive patients with relapsing remitting MS treated for 3 years. The neuropsychological tests, as well as relapse number and EDSS, were assessed at baseline and yearly for three years. The impact on cortical atrophy was also considered in a subgroup of them, and are thus to be considered as preliminary. Results showed a significant reduction in the number of impaired neuropsychological tests after three years, a significant decrease in annualized relapse rate at each time points compared to baseline and a stable EDSS. In the neuropsychological assessment, a significant improvement in memory, attention and executive function test scores was detected. Preliminary MRI data show that, while GM volume did not change at 3 years, a significantly greater parahippocampal and prefrontal gray matter density was noticed, the former correlating with neuropsychological improvement in a memory test. This study showed that therapy with Natalizumab is helpful in improving cognitive performance, and is likely to have a protective role on grey matter, over a three years follow-up.
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Affiliation(s)
- Flavia Mattioli
- Neuropsychology Unit, Spedali Civili of Brescia, Brescia, Italy
| | | | - Fabio Bellomi
- Neuropsychology Unit, Spedali Civili of Brescia, Brescia, Italy
| | | | - Ruggero Capra
- Multiple Sclerosis Center of the Spedali Civili of Brescia, Montichiari, Italy
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Vidal-Jordana A, Sastre-Garriga J, Rovira A, Montalban X. Treating relapsing-remitting multiple sclerosis: therapy effects on brain atrophy. J Neurol 2015; 262:2617-26. [PMID: 26041617 DOI: 10.1007/s00415-015-7798-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 05/22/2015] [Accepted: 05/25/2015] [Indexed: 01/06/2023]
Abstract
Multiple sclerosis (MS) is an immune-mediated disease of the central nervous system with a complex and heterogeneous pathology that may ultimately lead to neurodegeneration and brain atrophy. Brain volume loss in MS is known to occur early in the disease course and to be clinically relevant, as it has been related to disability progression. Nowadays, brain volume loss is relatively easy to measure with different automated, reproducible and accurate software tools. Therefore, most of (if not all) the newest clinical trials have incorporated brain volume outcomes as a measure of treatment effect. With this review, we aimed to update and summarize all existing data regarding brain volume and RRMS treatment in clinical trials as well as in open-label observational studies of drugs with positive results in its primary outcome in at least one phase III trial as of March 2014.
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Affiliation(s)
- Angela Vidal-Jordana
- Department of Neurology-Neuroimmunology and Multiple Sclerosis Centre of Catalonia (Cemcat), Edifici Cemcat, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, P. Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Jaume Sastre-Garriga
- Department of Neurology-Neuroimmunology and Multiple Sclerosis Centre of Catalonia (Cemcat), Edifici Cemcat, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, P. Vall d'Hebron 119-129, 08035, Barcelona, Spain.
| | - Alex Rovira
- Magnetic Resonance Unit, Radiology Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Xavier Montalban
- Department of Neurology-Neuroimmunology and Multiple Sclerosis Centre of Catalonia (Cemcat), Edifici Cemcat, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, P. Vall d'Hebron 119-129, 08035, Barcelona, Spain
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Sastre-Garriga J, Tur C, Pareto D, Vidal-Jordana A, Auger C, Río J, Huerga E, Tintoré M, Rovira A, Montalban X. Brain atrophy in natalizumab-treated patients: A 3-year follow-up. Mult Scler 2014; 21:749-56. [DOI: 10.1177/1352458514556300] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 09/26/2014] [Indexed: 11/16/2022]
Abstract
Background: A pseudoatrophy effect has been held responsible for the lack of net impact of natalizumab on brain volume outcomes in 2-year trials, but no data are available beyond 24 months. Objective: We aimed to investigate brain volume dynamics in natalizumab-treated patients in up to 3 years after therapy initiation with clinical correlations. Methods: Patients on natalizumab for at least 3 years were clinically assessed 3-monthly. Magnetic resonance imaging scans were performed at baseline and yearly. Brain volume changes were obtained with SIENA. Multivariate models were used to investigate the association between baseline inflammation and changes in brain volume and disability. Results: Sixty-two patients with multiple sclerosis were analysed. Mean age and disease duration were 34.7 (SD: 8.3) and 10.4 (SD: 6.6) years. Presence of gadolinium enhancement at baseline was not associated with Expanded Disability Status Scale changes ( p=0.468), but was associated with larger brain volume decreases ( p=0.005) in the first ( p=0.024) and second year ( p=0.019) but not in the third year ( p=0.863). Brain volume changes at 12 and 36 months were marginally associated with disability status at month 12 ( p=0.094) and 36 ( p=0.084), respectively. Conclusions: Baseline inflammation affects brain volume measures up to 24 months after natalizumab initiation. A marginal association of brain volume changes with disability is present.
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Affiliation(s)
- J Sastre-Garriga
- Servei de Neurologia / Neuroimmunologia, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - C Tur
- Servei de Neurologia / Neuroimmunologia, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - D Pareto
- Unitat de Ressonància Magnètica (Servei de Radiologia), Hospital universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - A Vidal-Jordana
- Servei de Neurologia / Neuroimmunologia, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - C Auger
- Unitat de Ressonància Magnètica (Servei de Radiologia), Hospital universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - J Río
- Servei de Neurologia / Neuroimmunologia, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - E Huerga
- Unitat de Ressonància Magnètica (Servei de Radiologia), Hospital universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - M Tintoré
- Servei de Neurologia / Neuroimmunologia, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - A Rovira
- Unitat de Ressonància Magnètica (Servei de Radiologia), Hospital universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - X Montalban
- Servei de Neurologia / Neuroimmunologia, Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
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