School of Biomedical Sciences and Pharmacy, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia.
Hunter Medical Research Institute, New Lambton, New South Wales, Australia.
J Neuroimaging. 2022 Nov;32(6):1109-1120. doi: 10.1111/jon.13032. Epub 2022 Aug 3.
Fingolimod has been shown to be more effective in reducing relapse rate and disability than injectable therapies in clinical trials. An increase in N-acetylaspartate (NAA) as measured by MR spectroscopy is correlated with maintaining axonal metabolic functions. This study compared the neurometabolic and volumetric changes in relapsing-remitting multiple sclerosis (RRMS) patients on fingolimod or injectable therapies with healthy controls (HCs).
Ninety-eight RRMS (52 on fingolimod, 46 on injectable therapies (27 on glatiramer acetate and 19 on interferon) were age and sex-matched to 51 HCs. RRMS patients underwent cognitive, fatigue, and mental health assessments, as well as an Expanded disability status scale (EDSS). MRI/S was acquired from the hippocampus, posterior cingulate gyrus (PCG), and prefrontal cortex (PFC). Volumetric and neurometabolic measures were compared across cohorts using a univariate general linear model and correlated with clinical severity and neuropsychological scores.
Clinical parameters, MR-volumetric, and neurometabolic profiles showed no differences between treatment groups (p > .05). Compared to HCs, both RRMS cohorts showed volume changes in white matter (-13%), gray matter (-16%), and cerebral spinal fluid (CSF) (+17-23%), as well as reduced NAA (-17%, p = .001, hippocampus), (-7%, p = .001, PCG), and (-9%, p = .001, PFC). MRI/S metrics in three regions were moderately correlated with cognition and fatigue functions.
While both treatment arms showed overall similar volumetric and neurometabolic profiles, longitudinal studies are warranted to clarify neurometabolic changes and associations with treatment efficacy.
在临床试验中，与注射疗法相比，芬戈莫德在降低复发率和残疾率方面更有效。磁共振波谱测量的 N-乙酰天门冬氨酸（NAA）增加与维持轴突代谢功能有关。本研究比较了接受芬戈莫德或注射疗法（27 例接受那他珠单抗，19 例接受干扰素）的复发缓解型多发性硬化症（RRMS）患者与健康对照者（HCs）的神经代谢和容积变化。
98 例 RRMS（52 例接受芬戈莫德治疗，46 例接受注射治疗）与 51 例 HCs 按年龄和性别匹配。RRMS 患者接受认知、疲劳和心理健康评估，以及扩展残疾状况量表（EDSS）评估。从海马体、后扣带回（PCG）和前额叶皮质（PFC）采集 MRI/S。使用单变量一般线性模型比较各组的容积和神经代谢测量值，并与临床严重程度和神经心理学评分相关。
临床参数、MR 容积和神经代谢特征在治疗组之间无差异（p>.05）。与 HCs 相比，两组 RRMS 患者的脑白质（-13%）、灰质（-16%）和脑脊液（CSF）（+17-23%）容积均发生变化，且 NAA 减少（-17%，p=.001，海马体）、（-7%，p=.001，PCG）和（-9%，p=.001，PFC）。三个区域的 MRI/S 指标与认知和疲劳功能中度相关。
虽然两种治疗方法的总体容积和神经代谢特征相似，但需要进行纵向研究以阐明神经代谢变化及其与治疗效果的关系。
