The following article is part of conference coverage from the 2021 Annual Meeting of the Consortium of Multiple Sclerosis Centers (CMSC), held October 25-28 2021, in Orlando, Florida. Neurology Advisor’s staff will be reporting breaking news associated with research conducted by leading experts in neurology. Check back for the latest news from the 2021 CMSC Annual Meeting.


Baseline magnetic resonance imaging (MRI) measures were found to be relevant for predicting 5-year decline or improvement of cognitive processing speed among patients with secondary progressive multiple sclerosis (SPMS). These findings were presented at the 2021 Meeting of the Consortium of Multiple Sclerosis Centers (CMSC), held October 25-28, 2021 in Orlando, Florida.

Patients with SPMS who received siponimod in the EXPAND study were associated with improved MRI lesion activity, total brain atrophy, gray matter atrophy, magnetization transfer ratio (MTR) measures, and cognitive processing speed.

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In this analysis, researchers assessed the predictive value of MRI measures among this patient population. Patients who had MRI (n=1099) and MTR (n=402) data at baseline were assessed for time-to-6-month confirmed Symbol Digit Modalities Test (SDMT) 4-point worsening or improvement over a period of 5 years.

The strongest MRI predictors for 6-month cognitive worsening among both patients in the best and worst quartiles were thalamic and cortical gray matter volumes (hazard ratio [HR] range, 1.46-2.30; both P <.05).

Patients who were in the worst quartile for normalized MTR of the normal-appearing brain tissue, T1-hypointense lesion volume, T2-lesion volume, and thalamic volume were less likely to exhibit 6-month cognitive improvement (HR range, 0.24-0.52; all P <.0120).

Absolute change in SDMT was associated with all baseline parameters except for gadolinium-enhancing T1 lesions. The most strongly associated feature was thalamic volume, followed by T1-hypointense lesion volume, T2-lesion volume, and normalized MTR of the normal-appearing brain tissue (delta range, 4.19-6.15; all P £.0107).

This study was limited by only including data from patients who received siponimod. These findings require confirmation among patients who were not receiving this therapy.

These data indicated MRI features, particularly thalamic volume and MTR-reflected myelination “were associated with clinically meaningful worsening or improvement in cognitive processing speed in siponimod-treated participants with SPMS, suggesting relevance as prognostic MRI measures of decline in cognitive processing speed both in short and longer terms,” the researchers concluded.

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.

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Benedict RHB, Penner I-K, Kappos L, et al. Baseline Magnetic Resonance Imaging Predictors of Cognitive Processing Speed in Participants with Secondary Progressive Multiple Sclerosis from the Phase 3 EXPAND Study. Presented at: CMSC 2021 Annual Meeting; October 25-28, 2021; Orlando, Florida. Abstract DMT54.