Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain.
Mult Scler. 2013 Aug;19(9):1175-81. doi: 10.1177/1352458512473190. Epub 2013 Jan 14.
Investigation of atrophy data from a pivotal natalizumab trial has demonstrated an increased rate of volume loss, compared to placebo, after the first year of therapy. It was considered to be probably due to a pseudoatrophy effect.
To assess grey and white matter volume changes and their relation to global brain volume changes and to baseline inflammation, for patients under natalizumab therapy.
We selected 45 patients on natalizumab therapy for at least 24 months, with magnetic resonance imaging (MRI) scans at baseline, 12 and 24 months. We calculated the percentage brain volume change (PBVC) for the first and second year, using SIENA software. Grey and white matter fractions (GMF and WMF, respectively) for the first year were calculated with SPM5, using lesion masks. After quality checks, six patients were excluded. We studied the predictive variables of change in brain volumes.
The PBVC decrease was faster during the first year (-1.10% ± 1.43%), as compared to the second (-0.51% ± 0.96%) (p = 0.037). These differences were more marked in patients with baseline gadolinium-enhancing lesions (p = 0.005). Mean GMF and WMF changes during the first year of treatment were +1.15% (n.s.) and -1.72% (p = 0.017), respectively. The presence of active lesions at baseline MRI predicted PBVC (p = 0.022) and WMF change (p = 0.026) during the first year of treatment, after adjusting for age and corticosteroid treatment. No predictors were found for GMF volume changes.
Early brain volume loss during natalizumab therapy is mainly due to WMF volume loss and it is related to the inflammatory activity present at the onset of therapy. We found that the pseudoatrophy effect is mostly due to white matter volume changes.
对关键那他珠单抗试验的萎缩数据进行研究后表明，与安慰剂相比，第一年治疗后容积丢失率更高。这可能归因于假性萎缩效应。
评估接受那他珠单抗治疗的患者的灰质和白质容积变化及其与全脑容积变化的关系，以及与基线炎症的关系。
我们选择了 45 名接受那他珠单抗治疗至少 24 个月的患者，在基线、12 个月和 24 个月时进行磁共振成像（MRI）扫描。我们使用 SIENA 软件计算第一年和第二年的脑容量变化百分比（PBVC）。使用 SPM5 软件和病变掩模计算第一年的灰质和白质分数（GMF 和 WMF）。经过质量检查后，排除了 6 名患者。我们研究了脑容量变化的预测变量。
第一年 PBVC 下降速度较快（-1.10%±1.43%），而第二年较慢（-0.51%±0.96%）（p=0.037）。在基线时存在钆增强病变的患者中，这种差异更为明显（p=0.005）。第一年治疗期间 GMF 和 WMF 的平均变化分别为+1.15%（无统计学意义）和-1.72%（p=0.017）。基线 MRI 上存在活动性病变可预测第一年治疗期间的 PBVC（p=0.022）和 WMF 变化（p=0.026），在调整年龄和皮质类固醇治疗后。未发现 GMF 容积变化的预测因素。
那他珠单抗治疗早期脑容积丢失主要是由于白质容积丢失，且与治疗开始时的炎症活动有关。我们发现假性萎缩效应主要归因于白质容积变化。
