Brain Atrophy as an Outcome of Disease-Modifying Therapy for Remitting-Relapsing Multiple Sclerosis

Area of Science:

• Neuroscience
• Immunology
• Radiology

Background:

• Clinical trials for disease-modifying therapies (DMTs) in multiple sclerosis (MS) focus on neuroinflammation and neurodegeneration.
• Brain atrophy and disability progression are key outcomes in assessing MS treatment efficacy.

Purpose of the Study:

• To evaluate the neuroprotective potential of current DMTs for MS.
• To assess the impact of DMTs on brain atrophy and clinical disability in relapsing-remitting MS (RRMS).

Main Methods:

• Systematic analysis of clinical trials (2008-2019) using brain atrophy outcomes (brain parenchymal fraction, brain volume loss).
• Inclusion of trials with published volumetric MRI data from baseline to at least 96 weeks.

Main Results:

• Twelve trials met inclusion criteria. DMTs like alemtuzumab and ocrelizumab showed significant reductions in brain volume loss (BVL) and disability worsening.
• Other DMTs (cladribine, teriflunomide) demonstrated moderate effects on brain atrophy and disability. Dimethyl fumarate and fingolimod showed inconsistent effects on BVL across trials.
• Peg-interferon-beta-1a had a modest effect on BVL and disability worsening.

Conclusions:

• Brain volume loss is a component of clinical disability worsening in RRMS.
• Standardizing atrophy measurement and disability criteria is crucial for comparing the neuroprotective potential of DMTs.