McManus Eileen J, Clark Karen M, Frampton Christopher, Macniven Jamie A B, Schepel Jan
Department of Neurology, Waikato Hospital, Hamilton, New Zealand.
Department of Medicine, University of Otago, Christchurch, New Zealand.
Mult Scler J Exp Transl Clin. 2022 Feb 23;8(1):20552173211070752. doi: 10.1177/20552173211070752. eCollection 2022 Jan-Mar.
Cognitive impairment and neuropsychiatric symptoms are frequently reported in Relapsing-Remitting Multiple Sclerosis (RRMS). Natalizumab (NTZ) is usually administered on a 4-weekly Standard Interval Dosing (SID) schedule. However, Extended Interval Dosing (EID) at 6-8 weekly intervals has been proven non-inferior regarding relapse risk, with a lower risk of Progressive Multifocal Leukoencephalopathy (PML). The impact of EID NTZ on neuropsychological deficits in RRMS has not been studied. To determine if EID NTZ demonstrates an improvement in neuropsychological parameters in RRMS patients. We performed a retrospective, observational analysis of 34 RRMS patients treated between August 2015-2017. Patients underwent baseline neuropsychological testing before commencing EID NTZ. A second evaluation was performed, on average 28 months after commencing treatment. Z scores at the initial assessment showed baseline cognitive impairment in multiple domains. 14/20 Z-scores showed an improvement post-NTZ and 5/14 reached statistical significance; namely Trails A (visual attention/processing speed), Line-orientation (visual-spatial), Picture-naming (word finding), Digital-Span (attention, executive function and memory) and Story-recall (memory). The Hospital Anxiety and Depression Scale (HADS) data remained unchanged. Correlation matrix showed no association between HADS scores, the time between assessments and the changes in Z scores. This data suggests the efficacy of EID NTZ in improving cognitive impairment in RRMS. A prospective observational study is warranted.
复发缓解型多发性硬化症（RRMS）患者常出现认知障碍和神经精神症状。那他珠单抗（NTZ）通常按照每4周一次的标准间隔给药（SID）方案进行给药。然而，已证实每6 - 8周一次的延长间隔给药（EID）在复发风险方面并不逊色，且进展性多灶性白质脑病（PML）风险更低。EID NTZ对RRMS患者神经心理缺陷的影响尚未得到研究。为了确定EID NTZ是否能改善RRMS患者的神经心理学参数。我们对2015年8月至2017年期间接受治疗的34例RRMS患者进行了一项回顾性观察分析。患者在开始EID NTZ治疗前接受了基线神经心理学测试。在开始治疗平均28个月后进行了第二次评估。初始评估时的Z评分显示多个领域存在基线认知障碍。14/20的Z评分在NTZ治疗后有所改善，其中5/14达到统计学显著水平；即连线测验A（视觉注意力/处理速度）、直线定向（视觉空间）、图片命名（找词）、数字广度（注意力、执行功能和记忆）以及故事回忆（记忆）。医院焦虑抑郁量表（HADS）数据保持不变。相关矩阵显示HADS评分、评估间隔时间与Z评分变化之间无关联。这些数据表明EID NTZ在改善RRMS患者认知障碍方面具有疗效。有必要进行一项前瞻性观察研究。
