“MRI is the biomarker that correlates with clinical outcomes best in MS and is increasingly being used to assess prognosis, risk stratification, response or non-response to treatment and the effectiveness of DMTs. When you develop a new Gd-enhancing lesion on MRI about 80% of these will leave behind a white scar on a T2 scan; about 1 in 4 T2 lesions are associated with a black-hole on the T1 scans. We know that black hole lesions are more destructive and are associated with greater loss of axons (nerve processes). It is therefore very reassuring to see that the new formulation of glatiramer acetate, not only reduces the number of new lesions but reduces the proportion that are converted to black holes, when compared to placebo. This implies that GA is neuroprotective and is either reducing the inflammation, which causes the damage, or it is protecting the axons in the lesion from degenerating. This will be good news for MSers who on GA and doing well. GA is a very safe drug when used long-term; it is a pity we can’t predict who will be a responder to the drug before we start anyone on GA. In my experience the majority of MSers on GA have breakthrough activity and need to be escalated to a more effective DMT within the first 2-4 years. However, the minority who don’t have breakthrough activity, i.e. are considered to have no evident disease activity (NEDA), do very well. I hope this study provides some food for thought as many Pharma companies are trying to promote switching to their drugs based on MSers being tired of taking injections. I am sure MSers who are doing well on GA may not want to change; a reasonable decision that is supported by data such as this.”
Epub: Zivadinov et al. Effect of glatiramer acetate three-times weekly on the evolution of new, active multiple sclerosislesions into T1-hypointense “black holes”: a post hoc magnetic resonance imaging analysis. J Neurol. 2014.