Increased Within-Network Functional Connectivity May Predict NEDA Status in Fingolimod-Treated MS Patients

Area of Science:

• Neuroscience
• Radiology
• Immunology

Background:

• Limited research exists on brain functional changes from multiple sclerosis (MS) disease-modifying therapies (DMTs).
• No prior studies have combined clinical and MRI outcomes to assess DMT-related functional connectivity (FC) predictive of short-term results.

Purpose of the Study:

• Investigate baseline FC differences between MS patients with and without evidence of disease activity (EDA) on DMT.
• Evaluate DMT-induced changes in FC.
• Explore relationships between DMT-related FC alterations and performance changes.

Main Methods:

• Utilized a dataset of 30 relapsing MS patients treated with fingolimod for 6 months.
• Defined treatment response using "no evidence of disease activity" (NEDA-3) status.
• Analyzed resting-state fMRI data for within- and between-network FC measures.

Main Results:

• Patients achieving NEDA (n=14) exhibited higher baseline within-network FC in several networks compared to EDA patients (n=16).
• NEDA patients showed reduced within-network FC and increased between-network FC post-treatment, alongside improved PASAT scores.
• PASAT improvements correlated with specific FC changes, particularly in the posterior default mode network.

Conclusions:

• NEDA status post-fingolimod is associated with higher baseline within-network FC in MS patients.
• Treatment leads to significant functional brain reorganization in NEDA patients.
• FC changes are linked to clinical improvements, suggesting a functional recovery mechanism.