Brain Atrophy as an Outcome of Disease-Modifying Therapy for Remitting-Relapsing Multiple Sclerosis

Introduction. Currently, clinical trials of DMTs strive to determine their effect on neuroinflammation and neurodegeneration. We aimed to determine the impact of currently used DMTs on brain atrophy and disability in RRMS. The main goal of this review is to evaluate the neuroprotective potential of...

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Veröffentlicht in:Multiple sclerosis international Jg. 2023; S. 1 - 11
Hauptverfasser: Chylińska, Magdalena, Komendziński, Jakub, Wyszomirski, Adam, Karaszewski, Bartosz
Format: Journal Article
Sprache:Englisch
Veröffentlicht: New York Hindawi 31.08.2023
John Wiley & Sons, Inc
Schlagworte:
Atrophy
Automation
Care and treatment
Clinical trials
Diagnostic imaging
Inflammation
Information processing
Magnetic resonance imaging
Methods
Monoclonal antibodies
Multiple sclerosis
Nervous system
Neurodegeneration
Processing speed
Review
Shrinkage
ISSN:2090-2654, 2090-2662
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Zusammenfassung:Introduction. Currently, clinical trials of DMTs strive to determine their effect on neuroinflammation and neurodegeneration. We aimed to determine the impact of currently used DMTs on brain atrophy and disability in RRMS. The main goal of this review is to evaluate the neuroprotective potential of MS therapy and assess its impact on disability. Methods. We performed a systematic analysis of clinical trials that used brain atrophy as an outcome or performed post hoc analysis of volumetric MRI parameters to assess the neuroprotective potential of applied therapies. Trials between 2008 and 2019 that included published results of brain parenchymal fraction (BPF) change and brain volume loss (BVL) in the period from baseline to week 96 or longer were considered. Results. Twelve from 146 clinical trials met the inclusion criteria and were incorporated into the analysis. DMTs that presented a large reduction in BVL also exhibited robust effects on clinical disability worsening, e.g., alemtuzumab with a 42% risk reduction in 6-month confirmed disability accumulation (p=0.0084), ocrelizumab with a 40% risk reduction in 6-month confirmed disability progression (p=0.003), and other DMTs (cladribine and teriflunomide) with moderate influence on brain atrophy were also associated with a marked impact on disability worsening. Dimethyl fumarate (DEFINE) and fingolimod (FREEDOMS I) initially exhibited significant effect on BVL; however, this effect was not confirmed in further clinical trials: CONFIRM and FREEDOMS II, respectively. Peg-IFN-β1a shows a modest effect on BVL and disability worsening. Conclusion. Our results show that BVL in one of the components of clinical disability worsening, together with other variables (lesion volume and annualized relapse rate). Standardization of atrophy measurement technique as well as harmonization of disability worsening and progression criteria in further clinical trials are of utmost importance as they enable a reliable comparison of neuroprotective potential of DMTs.
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Academic Editor: Sarah Orton
ISSN:2090-2654
2090-2662
DOI:10.1155/2023/4130557