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New acute and chronic black holes in patients with multiple sclerosis randomised to interferon beta-1b or glatiramer
D Cadavid1, J Cheriyan, J Skurnick
1Department of Neurology and Neuroscience, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, Newark, New Jersey, USA. cadavidi@umdnj.edu
Background:
Hypointense lesions on T1 weighted MRI, referred to as black holes (BH), are a marker of demyelination/axonal loss in multiple sclerosis (MS). There is some evidence that glatiramer acetate (GA) may decrease the conversion of new brain lesions to BH.
Methods:
Monthly 3-Tesla brain MRI scans were used for up to 2 years to study the development and evolution of new BH in 75 patients with MS randomised to GA or Interferon beta-1b (IFNbeta1b) in the BECOME study.
Findings:
Of 1224 newly enhancing lesions (NEL) appearing at baseline through 24 months in 61 patients, 767 (62.7%) showed an acute BH (ABH). The majority of ABH were transient and of similar duration by treatment group. Of 571 ABH in which MRI follow-up scans were available for >or=1 year, 103 (18.8%) were still visible >or=12 months after onset and were considered chronic BH (CBH). Only 12.1% of the 849 NEL with MRI follow-up >or=1 year converted to CBH, 9.8% with IFNbeta1b and 15.2% with GA (p = 0.02). The conversion from ABH to CBH was also lower with IFNbeta1b (15.2%) than with GA (21.4%), of borderline significance (p = 0.06). The majority of patients who developed NEL did not develop CBH; however, about a quarter had conversion rates from ABH to CBH greater than 20%.
Interpretation:
Only a minority of new brain lesions in patients with MS treated with GA or IFNbeta1b convert to CBH.
Insights
Black holes (BH) in multiple sclerosis (MS) brain lesions are markers of damage. This study found that only a minority of new lesions convert to chronic BH in MS patients treated with glatiramer acetate or Interferon beta-1b.
Area of Science:
- Neuroimaging
- Neurology
- Multiple Sclerosis Research
Background:
- Black holes (BH) on T1-weighted MRI indicate demyelination and axonal loss in multiple sclerosis (MS).
- Glatiramer acetate (GA) may reduce the development of BH from new brain lesions.
Purpose of the Study:
- To investigate the development and evolution of new BH in MS patients.
- To compare the conversion rates of new brain lesions to chronic BH between GA and Interferon beta-1b (IFNbeta1b) treatment groups.
Main Methods:
- Monthly 3-Tesla brain MRI scans were collected for up to 2 years.
- The study included 75 MS patients randomized to GA or IFNbeta1b in the BECOME study.
- Development and evolution of new BH from newly enhancing lesions (NEL) were analyzed.
Main Results:
- Of 1224 NEL, 62.7% showed acute BH (ABH).
- Only 12.1% of NEL with follow-up converted to chronic BH (CBH), with lower rates for IFNbeta1b (9.8%) versus GA (15.2%) (p=0.02).
- Conversion from ABH to CBH was also lower with IFNbeta1b (15.2%) than GA (21.4%) (p=0.06).
Conclusions:
- A minority of new brain lesions in MS patients treated with GA or IFNbeta1b convert to chronic BH.
- Treatment with IFNbeta1b may be associated with a lower conversion rate to chronic BH compared to GA.
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