Multimodal MRI Response to Fingolimod in Multiple Sclerosis: A Nonrandomized, Single Arm, Observational Study

Area of Science:

• Neuroimaging
• Neurology
• Radiology

Background:

• Fingolimod shows benefits in conventional MRI but its neuroprotective capacity remains unclear.
• Investigating fingolimod's effects on both lesion and normal-appearing white matter (NAWM) is crucial for understanding its full impact.

Purpose of the Study:

• To assess changes in conventional and advanced MRI measures in lesions and NAWM over two years in patients with multiple sclerosis treated with fingolimod.
• To evaluate potential neuroreparative effects of fingolimod.

Main Methods:

• Fifty relapsing-remitting multiple sclerosis patients and 27 controls underwent 3T MRI scans at baseline, 1 year, and 2 years.
• Advanced MRI metrics including magnetization transfer ratio (MTR), fractional anisotropy (FA), and median diffusivity (MD) were calculated for lesions and NAWM.
• Longitudinal changes were analyzed using repeated measures ANOVA with Bonferroni correction.

Main Results:

• Conventional MRI measures showed no significant changes.
• Significant improvements were observed in lesion magnetization transfer ratio (MTR) and fractional anisotropy (FA), along with changes in lesion median diffusivity (MD).
• Normal-appearing white matter (NAWM) fractional anisotropy (FA) showed significant improvement over two years, while NAWM-MD also changed significantly within the first year.

Conclusions:

• Fingolimod treatment may exert a neuroreparative effect on both MS lesions and NAWM.
• Further large-scale, randomized studies are necessary to confirm these promising findings on fingolimod's neuroprotective potential.