Objectives: This study investigated the evolution of cortical atrophy in MSers with early relapsing-remitting (RR) MS and its association with lesion volume (LV) accumulation and disability progression.
Methods: 136 of 181 RRMSers who participated in the Avonex-Steroids-Azathioprine study were assessed bimonthly for clinical and MRI outcomes over 2 years. MSers with disease duration (DD) at baseline of ≤24 months were classified in the early group (DD of 1.2 years, n = 37), while MSers with DD > 24 months were classified in the late group (DD of 7.1 years, n = 99). Mixed effect model analysis was used to investigate the associations.
Results: Significant changes in whole brain volume (WBV) (P < 0.001), cortical volume (CV) (P < 0.001), and in T2-LV (P < 0.001) were detected. No significant MRI percent change differences were detected between early and late DD groups over 2 years, except for increased T2-LV accumulation between baseline and year 2 in the early DD group (P < 0.01). No significant associations were found between changes in T2-LV and CV over the follow-up. Change in CV was related to the disability progression over the 2 years, after adjusting for DD (P = 0.01).
Conclusion: Significant cortical atrophy, independent of T2-LV accumulation, occurs in early RRMS over 2 years, and it is associated with the disability progression.
|CV: cortical volume, WBV: whole brain volume, and LV: lesion volume
“This study confirms what we already know from several other studies that MS is associated with progressive brain atrophy that begins early in the disease and is associated with disability progression. This is why it is important to treat MS early, aggressively and actively. Actively means not to assume a clinical response is good enough, i.e. to monitor with MRI and to switch or escalate treatment if there are signs of a non-response. Now that we have drugs that reduce or slow the rate of brain atrophy we need to consider incorporating this variable into our clinical practice.”