A two-year study using cerebral gray matter volume to assess the response to fingolimod therapy in multiple sclerosis

• Published in: Journal of the neurological sciences 2017-12, Vol.383, p.221-229
• Main Authors: Yousuf, Fawad, Dupuy, Sheena L., Tauhid, Shahamat, Chu, Renxin, Kim, Gloria, Tummala, Subhash, Khalid, Fariha, Weiner, Howard L., Chitnis, Tanuja, Healy, Brian C., Bakshi, Rohit
• Format: Article
• Language: English
• Subjects: Adult; Atrophy - diagnostic imaging; Atrophy - drug therapy; Atrophy - pathology; Brain - diagnostic imaging; Brain - drug effects; Brain - pathology; Cerebral gray matter atrophy; Disability Evaluation; Disease-modifying therapy; Female; Fingolimod; Fingolimod Hydrochloride - therapeutic use; Gray Matter - diagnostic imaging; Gray Matter - drug effects; Gray Matter - pathology; Humans; Linear Models; Magnetic Resonance Imaging; Male; Middle Aged; MRI; Multiple sclerosis; Multiple Sclerosis - diagnostic imaging; Multiple Sclerosis - drug therapy; Multiple Sclerosis - pathology; Multiple Sclerosis, Relapsing-Remitting - drug therapy; Multiple Sclerosis, Relapsing-Remitting - pathology; Organ Size; Retrospective Studies; Time Factors; Treatment Outcome; Young Adult
• ISSN: 0022-510X; 1878-5883
• DOI: 10.1016/j.jns.2017.10.019

Cerebral gray matter (GM) atrophy has clinical relevance in multiple sclerosis (MS). Fingolimod has known efficacy on clinical and conventional MRI findings in MS; the effect on GM is unknown. To explore fingolimod's treatment effect on cerebral GM atrophy over two years in patients with relapsing forms of MS. Patients starting fingolimod [n=24, age (mean±SD) 41.2±11.6years, Expanded Disability Status Scale (EDSS) score 1.1±1.4; 58% women] were compared to untreated patients [n=29, age 45.7±8.4years, EDSS 1.0±1.2; 93% women]. Baseline, one and two year MRI was applied to an SPM12 pipeline to assess brain parenchymal fraction (BPF) and cortical GM fraction (cGMF). T2 lesion volume (T2LV) and gadolinium-enhancing lesions were assessed. Change was modeled using a mixed effects linear regression with a random intercept and fixed effects for time, group, and the time-by-group interaction. The group slope difference was assessed using the interaction term. Over two years, cGMF remained stable in the fingolimod group (p>0.05), but decreased in the untreated group (p