Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, MD, USA.
Mult Scler. 2020 Mar;26(3):312-321. doi: 10.1177/1352458519826364. Epub 2019 Feb 11.
The effects of disease-modifying therapies (DMTs) on region-specific brain atrophy in multiple sclerosis (MS) are unclear.
To determine the effects of higher versus lower efficacy DMTs on rates of brain substructure atrophy in MS.
A non-randomized, observational cohort of people with MS followed with annual brain magnetic resonance imaging (MRI) was evaluated retrospectively. Whole brain, subcortical gray matter (GM), cortical GM, and cerebral white matter (WM) volume fractions were obtained. DMTs were categorized as higher (DMT-H: natalizumab and rituximab) or lower (DMT-L: interferon-beta and glatiramer acetate) efficacy. Follow-up epochs were analyzed if participants had been on a DMT for ⩾6 months prior to baseline and had at least one follow-up MRI while on DMTs in the same category.
A total of 86 DMT epochs (DMT-H: = 32; DMT-L: = 54) from 78 participants fulfilled the study inclusion criteria. Mean follow-up was 2.4 years. Annualized rates of thalamic (-0.15% vs -0.81%; = 0.001) and putaminal (-0.27% vs -0.73%; = 0.001) atrophy were slower during DMT-H compared to DMT-L epochs. These results remained significant in multivariate analyses including demographics, clinical characteristics, and T2 lesion volume.
DMT-H treatment may be associated with slower rates of subcortical GM atrophy, especially of the thalamus and putamen. Thalamic and putaminal volumes are promising imaging biomarkers in MS.
疾病修正疗法（DMT）对多发性硬化症（MS）特定区域脑萎缩的影响尚不清楚。
确定更高与更低疗效 DMT 对 MS 脑亚结构萎缩率的影响。
回顾性评估了一项非随机、观察性 MS 患者队列，每年进行脑磁共振成像（MRI）检查。获得全脑、皮质下灰质（GM）、皮质 GM 和脑白质（WM）体积分数。将 DMT 分为更高（DMT-H：那他珠单抗和利妥昔单抗）或更低（DMT-L：干扰素-β和聚乙二醇干扰素）疗效。如果参与者在基线前至少有 6 个月接受 DMT 治疗且在同一类别 DMT 治疗期间至少有一次后续 MRI，则分析随访期。
共有 78 名参与者的 86 个 DMT 时期（DMT-H：=32；DMT-L：=54）符合研究纳入标准。平均随访时间为 2.4 年。DMT-H 与 DMT-L 时期相比，丘脑（-0.15%对-0.81%；=0.001）和壳核（-0.27%对-0.73%；=0.001）萎缩的年发生率较慢。在包括人口统计学、临床特征和 T2 病变体积在内的多变量分析中，这些结果仍然具有统计学意义。
DMT-H 治疗可能与皮质下 GM 萎缩率较慢有关，特别是丘脑和壳核。丘脑和壳核体积是 MS 有前途的成像生物标志物。
