Effects of disease modifying therapies on brain and grey matter atrophy in relapsing remitting multiple sclerosis

Abstract

Background: Progressive brain atrophy is a major feature of multiple sclerosis (MS) pathology and is actually considered a major determinant of the progressive accumulation of physical and cognitive disability in MS patients. Although brain atrophy may have different pathological substrates, several lines of evidence suggest that in disease modifying drug (DMD)-treated MS patients, the higher is the anti-inflammatory effect of the DMD the lower is the progression of brain volume loss, grey matter atrophy and the accumulation of disability. Areas covered: Magnetic resonance imaging (MRI)-based measurements of inflammation (focal white matter and grey matter lesions) and neurodegeneration (decrease in brain volume, cortical and deep grey matter atrophy) are currently included among the primary or secondary end-points of Phase II and III randomized clinical trials (RCT). This review summarizes literature data on the effects of DMDs on either whole brain or grey matter atrophy emerged from RCT and from post-marketing studies.

Longitudinal patterns of cortical thinning in multiple sclerosis

“…Nevertheless, in our cohort, 64% of patients were treated with disease‐modifying including primarily first‐line injectables (60%). While injectables also show an effect on brain gray matter atrophy, based on previous studies, we believe that this effect is rather negligible (Favaretto, Lazzarotto, Margoni, Poggiali, & Gallo, ). During the collection of data in this study, there was no approved treatment for PPMS, so that no patient received treatment in this patient group.…”

Classification of multiple sclerosis based on patterns of CNS regional atrophy covariance

“…Indeed, patients of Group A were less commonly treated compared to Group C, whereas the distribution of treatments used in Group C was different compared to Group D. However, it is unclear, if and to which extent this could influence the presence of distinct patterns of VLOT in our patients and consequently our classification results. Nevertheless, the majority of our patients were treated with first-line injectables, which have been shown to have a negligible effect on CNS-atrophy (Favaretto, Lazzarotto, Margoni, Poggiali, & Gallo, 2018). Another potential limitation of our longitudinal experimental design relates to potential volumetric measurement variability due to methodological or physiological factors.…”

Spinal cord volume loss

“…While injectables also show an effect on brain atrophy, we believe that this effect is rather negligible. 33 Finally, since the study had no T2weighted sequence covering the area of volume measurement over all time points analyzed here, the impact of SC lesions was not assessed.…”