To B or Not to B..that’s is ProfG’s Atrophy Question


Effect of disease-modifying therapies on subcortical gray matter atrophy in multiple sclerosis.Sotirchos ES, Gonzalez-Caldito N, Dewey BE, Fitzgerald KC, Glaister J, Filippatou A, Ogbuokiri E, Feldman S, Kwakyi O, Risher H, Crainiceanu C, Pham DL, Van Zijl PC, Mowry EM, Reich DS, Prince JL, Calabresi PA, Saidha S. Mult Scler. 2019 Feb 11:1352458519826364.

BACKGROUND:The effects of disease-modifying therapies (DMTs) on region-specific brain atrophy in multiple sclerosis (MS) are unclear.

OBJECTIVE: To determine the effects of higher versus lower efficacy DMTs on rates of brain substructure atrophy in MS.

METHODS:A non-randomized, observational cohort of people with MS followed with annual brain magnetic resonance imaging (MRI) was evaluated retrospectively. Whole brain, subcortical gray matter (GM) (underneath the outside of the brain), cortical GM (outside of the brain) , and cerebral white matter (WM) volume (bits containing the nerve fibres) fractions were obtained. DMTs were categorized as higher (DMT-H: natalizumab and rituximab) or lower (DMT-L: interferon-beta and glatiramer acetate) efficacy. Follow-ups were analyzed if participants had been on a DMT for ⩾ (longer than) 6 months prior to baseline (beginning) and had at least one follow-up MRI while on DMTs in the same category.

RESULTS: A total of 86 DMT epochs (DMT-H: n = 32; DMT-L: n = 54) from 78 participants fulfilled the study inclusion criteria. Mean follow-up was 2.4 years. Annualized rates of thalamic (-0.15% vs -0.81%; p = 0.001) and putaminal (-0.27% vs –0.73%; p = 0.001) atrophy were slower during DMT-H compared to DMT-L.

CONCLUSION: DMT-H treatment may be associated with slower rates of subcortical GM atrophy, especially of the thalamus and putamen. Thalamic and putaminal volumes are promising imaging biomarkers in MS

So is it time to coin a term once made by a Dutch Colleague of ours to say “It’s (or should I say they are) rubbish throw it (them) in the bin”.

Yet more evidence of low efficacy treatments allowing your brain reserve to be eaten.Do we need more evidence?

Yes they work for some people, but not for the majority.

Remember Beware of the Dinosaurs (Dinosaur Neurologist)

CoI: Multiple

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  • Interesting post! This i off topic but the post got me wondering if there is such a thing as spinal atrophy that can be drivning progression together with brain atrophy in MS? Or is it just in the brain?

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