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Effect of teriflunomide on gray and white matter brain pathology in multiple sclerosis using volumetric and
Robert Zivadinov1, Niels Bergsland2, Jesper Hagemeier2
1Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, NY, USA; Center for Biomedical Imaging at the Clinical Translational Science Institute, University at Buffalo, State University of New York, NY, USA.
Objectives:
To investigate the effect of teriflunomide on microstructural pathology in the gray matter (GM) and white matter (WM), as measured by changes in brain volume and diffusion-tensor imaging (DTI) in patients with multiple sclerosis (MS).
Methods:
30 relapsing MS patients and 20 healthy controls (HCs) were enrolled in the study and followed prospectively for 12 months with clinical and 3T MRI examinations. Of those, 26 MS patients and 18 HCs completed the 6-month and 22 MS and 16 HCs patients the 12-month follow-up. Whole brain, GM, WM and thalamus volumes, and global and tract-based spatial statistics (TBSS) DTI measures of fractional anisotropy, mean, axial and radial diffusivity were obtained in the thalamus and normal appearing WM (NAWM). MRI differences between the groups were compared using non-parametric statistical methods due to sample size limitations, followed by post-hoc covariate-adjusted models.
Results:
At baseline, MS patients showed more severe brain volume and DTI measures compared to HCs (p < .05). At follow-up, no significant differences for brain volume and global and TBSS DTI measures between MS patients and HCs were found. No clinical progression or serious adverse events occurred in MS patients over the follow-up.
Conclusions:
MS patients did not significantly deteriorate over the follow-up in brain volume or thalamus/NAWM global or TBSS DTI measures, compared to HCs. This suggests that treatment with teriflunomide could potentially slow down accumulation of microstructural tissue damage in the GM and NAWM.
Insights
Teriflunomide treatment may slow brain tissue damage in multiple sclerosis (MS) patients. The study found no significant differences in brain volume or white matter integrity between MS patients and healthy controls after 12 months of treatment.
Area of Science:
- Neuroscience
- Immunology
- Radiology
Background:
- Multiple sclerosis (MS) is a chronic autoimmune disease characterized by inflammation and neurodegeneration.
- Microstructural pathology in gray matter (GM) and white matter (WM) contributes to MS progression.
- Teriflunomide is an immunomodulatory drug used to treat relapsing forms of MS.
Purpose of the Study:
- To evaluate the effect of teriflunomide on brain volume and diffusion-tensor imaging (DTI) measures in MS patients.
- To assess microstructural changes in GM and WM over a 12-month period.
- To compare MS patients treated with teriflunomide to healthy controls (HCs).
Main Methods:
- Prospective study of 30 relapsing MS patients and 20 HCs over 12 months.
- 3T MRI examinations including whole brain, GM, WM, and thalamus volumes.
- Tract-based spatial statistics (TBSS) DTI measures (fractional anisotropy, mean, axial, and radial diffusivity) in thalamus and normal-appearing WM (NAWM).
- Non-parametric statistical methods for group comparisons.
Main Results:
- At baseline, MS patients exhibited more severe brain volume and DTI abnormalities compared to HCs (p < .05).
- Over 12 months, no significant differences in brain volume or DTI measures were observed between MS patients and HCs.
- No clinical progression or serious adverse events were reported in the MS group.
Conclusions:
- Teriflunomide treatment did not lead to significant deterioration in brain volume or microstructural measures in MS patients over 12 months.
- These findings suggest teriflunomide may help slow the accumulation of tissue damage in the GM and NAWM.
- Further research is warranted to confirm the long-term neuroprotective effects of teriflunomide in MS.
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