Disease Modifying Therapy Associated With Persistent Brain Atrophy Slowing in MS

Investigators examine the effect of disease-modifying therapy on the rate of brain atrophy in patients with multiple sclerosis.

The following article is part of conference coverage from the 34th Congress of the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) in Berlin, Germany. 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 ECTRIMS 2018.

In patients with multiple sclerosis (MS), brain atrophy appears to continue to slow with each additional year of treatment with disease-modifying therapies (DMTs), according to a study presented at the 34th Congress of the European Committee for Treatment and Research in Multiple Sclerosis meeting, held October 10 to 12, 2018, in Berlin, Germany.

“The effect of DMT on brain atrophy has mostly been reported from [randomized controlled trials] and extension phases, where the duration of on-study DMT exposure is fixed and the effect is measured at the group level,” the investigators noted. “In a unique dataset from a large observational study where all pre-study and on-study DMT exposure (i.e. lifetime cumulative DMT exposure; LC-DMT) was recorded for each patient, we examine the effect of LC-DMT on brain atrophy at the individual level.”

A total of 405 patients with relapsing MS who were or were not treated with DMT based on clinician judgment were enrolled from a single center. Patients underwent annual standardized 3T magnetic resonance imaging scans and routine clinic visits between 2005 and 2010. At each magnetic resonance imaging scan time point, the investigators calculated LC-DMT and also assessed the percentage change in whole brain (SIENA), grey matter (total, cortical, and subcortical), thalamic, and white matter volumes from baseline as it related to lifetime cumulative DMT. Analyses were adjusted for age, duration of disease, sex, lesion volume at baseline, and new T2 lesions that developed over time.

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Among the patients included in the final analysis, a total of 1912 magnetic resonance imaging scans were recorded and available for assessment. In the overall cohort, the mean time of DMT exposure was 5.2±3.3 years (range, 0.03-16.4 years). Each year of additional lifetime cumulative DMT exposure was associated with a slowing progression in the atrophy rate in each brain region, according to findings in the adjusted analysis.

Specifically, each additional lifetime cumulative DMT year of exposure correlated with an attenuation rate of 0.017%±0.005% (P <.01) in the rate of atrophy. For example, there was a −1.475% per year change with 1 year of LC-DMT, a −1.458% per year change with 2 years of LC-DMT, and a −1.44% per year change with 3 years of LC-DMT. The investigators observed similar changes in the total grey matter (0.060%±0.007%; P <.01), cortical grey matter (0.054%±0.006%; P <.01), subcortical grey matter (0.014%±0.007%; P =.04), thalamic (0.056%±0.009%; P <.01), and white matter volumes (0.043%±0.006%; P <.01).

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Azevedo C. Lifetime cumulative DMT exposure is associated with a slower rate of brain atrophy. Presented at: 34th Congress of the European Committee for Treatment and Research in Multiple Sclerosis; October 10-12, 2018; Berlin, Germany. Abstract P1188.