Honce Justin M, Nair Kavita V, Hoyt Brian D, Seale Rebecca A, Sillau Stefan, Engebretson Eric, Schurr Brittany, Corboy John R, Vollmer Timothy L, Alvarez Enrique
Department of Radiology, University of Colorado Hospital, Aurora, CO, United States.
Department of Clinical Pharmacy, University of Colorado, Aurora, CO, United States.
Front Neurol. 2020 Sep 23;11:1045. doi: 10.3389/fneur.2020.01045. eCollection 2020.
Clinically stable multiple sclerosis (MS) patients on long-term therapy often have negligible acute inflammation on MRI. Brain atrophy may provide insight into subclinical disease progression in such populations. This study aims to compare brain atrophy for age- and gender-matched MS patients treated for >2 years with fingolimod (FTY) or glatiramer acetate (GA), examining brain volume, cognition, and patient-reported outcomes (PROs). Stable relapsing-MS patients, age 18-60, on FTY or GA for >2 years were followed up for 2 years. MRI brain and lesion volumes, cognitive measures, and PROs were collected at baseline and annually. Forty-four FTY and forty-three GA patients completed baseline and year 2 visits. No differences in age, gender, or education were observed. Median EDSS was 2.0 and 2.5 ( = 0.22). Treatment duration was longer for GA, 6.50 vs. 3.73 years ( < 0.001). Baseline geometric mean T2LV were different, GA = 1,009.29 cm vs. FTY = 2,404.67 cm ( = 0.0071). Baseline brain volumes were similar, GA = 1,508 cm vs. FTY = 1,489 cm ( = 0.2381). Annualized atrophy rates, adjusted for baseline and at mean baseline value, were GA = -0.2775% vs. FTY = -0.2967% ( = 0.7979). No differences in cognitive measures or PROs were observed. Stable MS patients on long-term treatment with FTY and GA have similar brain volume loss rates. Differences in baseline disease severity may suggest patients with more aggressive disease treated with FTY may achieve similar brain volume loss rates as patients with milder baseline disease on GA.
长期接受治疗的临床稳定的多发性硬化症（MS）患者在MRI上通常急性炎症可忽略不计。脑萎缩可能有助于洞察这类人群的亚临床疾病进展。本研究旨在比较接受芬戈莫德（FTY）或醋酸格拉替雷（GA）治疗超过2年的年龄和性别匹配的MS患者的脑萎缩情况，检查脑容量、认知功能和患者报告结局（PROs）。对年龄在18 - 60岁、接受FTY或GA治疗超过2年的稳定复发型MS患者进行了2年的随访。在基线和每年收集脑部MRI和病变体积、认知测量指标以及PROs。44例接受FTY治疗和43例接受GA治疗的患者完成了基线和第2年的访视。未观察到年龄、性别或教育程度方面的差异。EDSS中位数分别为2.0和2.5（P = 0.22）。GA组的治疗持续时间更长，为6.50年，而FTY组为3.73年（P < 0.001）。基线几何平均T2LV不同，GA组为1,009.29 cm³，FTY组为2,404.67 cm³（P = 0.0071）。基线脑容量相似，GA组为1,508 cm³，FTY组为1,489 cm³（P = 0.2381）。经基线校正和平均基线值调整后的年化萎缩率，GA组为 -0.2775%，FTY组为 -0.2967%（P = 0.7979）。未观察到认知测量指标或PROs方面的差异。接受FTY和GA长期治疗的稳定MS患者脑容量丢失率相似。基线疾病严重程度的差异可能表明，接受FTY治疗的病情更严重的患者可能与接受GA治疗的基线病情较轻的患者脑容量丢失率相似。
