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Impact of oral Cladribine on paramagnetic rim lesions of Multiple Sclerosis patients
Mariano Marrodan1, Paulina Yañez2, Ismael L Calandri3
1Departament of Neurology, Fleni. Buenos Aires, Argentina.
Background:
Paramagnetic rim lesions (PRLs), marked by chronic inflammation and iron-loaded microglia, are linked to severe disease progression in multiple sclerosis (MS). The impact of cladribine, an immune reconstitution therapy, on PRLs remains underexplored.
Objective:
To evaluate the effect of cladribine tablets on PRLs in relapsing-remitting MS (RRMS) patients and explore the association between PRLs dynamics and brain atrophy.
Methods:
We conducted a retrospective analysis of 52 RRMS patients treated with cladribine in Buenos Aires between 2018 and 2021. Brain MRIs were analyzed at baseline, 12, and 24 months post-treatment, focusing on PRLs count and brain volume measurements. Statistical analyses included Wilcoxon tests, Poisson mixed models, and linear mixed models.
Results:
The cohort included 52 patients (32 women) with a median age of 36 years (range 21-66 years). PRLs were present in 61.5% of patients at baseline. Cladribine treatment significantly reduced PRLs count (IRR=0.68, 95% CI [0.49, 0.95], p=0.02), independent of prior treatment or disease activity. While no significant relationship was found between PRLs changes and overall brain atrophy, a significant interaction between PRLs dynamics and atrophy in the right thalamus was observed (p<0.05).
Conclusion:
Cladribine tablets are associated with a reduction in PRLs in RRMS patients, potentially influencing regional brain atrophy over time.
Insights
Cladribine tablets significantly reduced paramagnetic rim lesions (PRLs) in multiple sclerosis (MS) patients. This immune therapy may influence regional brain atrophy, offering new insights into MS progression.
Area of Science:
- Neuroimmunology
- Radiology
- Clinical Neurology
Background:
- Paramagnetic rim lesions (PRLs) indicate chronic inflammation and are associated with severe multiple sclerosis (MS) progression.
- The effect of cladribine, an immune reconstitution therapy, on PRLs in MS is not well understood.
Purpose of the Study:
- To assess the impact of cladribine tablets on PRLs in relapsing-remitting MS (RRMS) patients.
- To investigate the relationship between PRLs changes and brain atrophy following cladribine treatment.
Main Methods:
- Retrospective analysis of 52 RRMS patients treated with cladribine (2018-2021).
- Brain MRI analysis at baseline, 12, and 24 months for PRLs count and brain volume.
- Statistical analysis using Wilcoxon tests, Poisson mixed models, and linear mixed models.
Main Results:
- Cladribine treatment significantly decreased PRLs count (IRR=0.68, p=0.02), irrespective of prior treatments or disease activity.
- No significant association was found between overall brain atrophy and PRLs changes.
- A significant interaction was observed between PRLs dynamics and atrophy in the right thalamus (p<0.05).
Conclusions:
- Cladribine tablets demonstrate efficacy in reducing PRLs in RRMS patients.
- PRLs dynamics may play a role in regional brain atrophy, particularly in the thalamus, over time.
