Wiebenga O T, Schoonheim M M, Hulst H E, Nagtegaal G J A, Strijbis E M M, Steenwijk M D, Polman C H, Pouwels P J W, Barkhof F, Geurts J J G
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.)
Anatomy and Neurosciences (O.T.W., M.M.S., H.E.H., G.J.A.N., J.J.G.G.).
AJNR Am J Neuroradiol. 2016 Jun;37(6):1030-7. doi: 10.3174/ajnr.A4690. Epub 2016 Mar 10.
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.
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.
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).
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.
那他珠单抗治疗对复发缓解型多发性硬化症有显著影响，可能是通过抑制白质损伤实现的。本研究采用扩散张量成像技术，调查复发缓解型多发性硬化症患者在接受那他珠单抗治疗的第一年中白质扩散率的变化。
本研究纳入了在基线时开始使用那他珠单抗的复发缓解型多发性硬化症患者（n = 22）、继续使用干扰素-β或醋酸格拉替雷的复发缓解型多发性硬化症患者（n = 17）以及健康对照者（n = 12）。在基线和第12个月时分析扩散张量成像参数。我们使用诸如分数各向异性等扩散张量成像参数来测量白质损伤的范围和严重程度，并在两个时间点将患者组与健康对照者进行比较。
那他珠单抗组白质损伤的范围和严重程度随时间显著降低（基于分数各向异性的范围，从56.8%降至47.2%；严重程度，z值从 -0.67降至 -0.59；P = 0.02）；在干扰素-β/醋酸格拉替雷组未观察到这种降低（范围，从41.4%降至39.1%，严重程度，z值从 -0.64降至 -0.67；P = 0.94）。患者组的认知功能随时间未发生变化，但与损伤严重程度相关（r = 0.53，P = < 0.001）。
在开始接受那他珠单抗治疗的复发缓解型多发性硬化症患者中，治疗的第一年白质损伤的范围和严重程度显著降低。这些发现可能有助于解释观察到的那他珠单抗在复发缓解型多发性硬化症中显著的临床效果。
