Current Status of Oral Disease-Modifying Treatment Effects on Cognitive Outcomes in Multiple Sclerosis: A Scoping Review

Abstract

Introduction. Cognitive impairment represents one of the most hidden and disabling clinical aspects of multiple sclerosis (MS). In this regard, the major challenges are represented by the need for a comprehensive and standardised cognitive evaluation of each patient, both at disease onset and during follow-up, and by the lack of clear-cut data on the effects of treatments. In the present review, we summarize the current evidence on the effects of the available oral disease-modifying treatments (DMTs) on cognitive outcome measures. Materials and Methods. In this systematised review, we extract all the studies that reported longitudinally acquired cognitive outcome data on oral DMTs in MS patients. Results. We found 29 studies that evaluated at least one oral DMT, including observational studies, randomised controlled trials, and their extension studies. Most of the studies (n = 20) evaluated sphingosine-1-phosphate (S1P) modulators, while we found seven studies on dimethyl fumarate, six on teriflunomide, and one on cladribine. The most frequently used cognitive outcome measures were SDMT and PASAT. Most of the studies reported substantial stability or mild improvement in cognitive outcomes in a short-time follow-up (duration of most studies ≤2 years). A few studies also reported MRI measures of brain atrophy. Conclusion. Cognitive outcomes were evaluated only in a minority of prospective studies on oral DMTs in MS patients with variable findings. More solid and numerous data are present for the S1P modulators. A standardised cognitive evaluation remains a yet unmet need to better clarify the possible positive effect of oral DMTs on cognition.

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“…Previous studies that have carried out disease-modifying treatments (DMTs) and investigated their effects on cognition point to a benefit for cognitive performance by reducing the development of new lesions and the progression of cerebral atrophy [ 16 , 17 ]. However, new studies with DMTs have shown stability or a mild improvement in cognitive outcomes in a short-time follow-up (the duration of most studies is ≤2 years) [ 18 ]. Nevertheless, the studies do not report a standard cognitive evaluation and the placebo effect, the possible effect of other CNS drugs, and the time needed under DMTs to prevent CI are unclear in most of the observations [ 17 , 18 ].…”

“…However, new studies with DMTs have shown stability or a mild improvement in cognitive outcomes in a short-time follow-up (the duration of most studies is ≤2 years) [ 18 ]. Nevertheless, the studies do not report a standard cognitive evaluation and the placebo effect, the possible effect of other CNS drugs, and the time needed under DMTs to prevent CI are unclear in most of the observations [ 17 , 18 ].…”