1. Long-term neuroprotective effects of natalizumab and fingolimod in multiple sclerosis: Evidence from real-world clinical data.
- Author
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Noteboom S, Strijbis EMM, Coerver EME, Colato E, van Kempen ZLE, Jasperse B, Vrenken H, Killestein J, Schoonheim MM, and Steenwijk MD
- Subjects
- Humans, Female, Male, Adult, Middle Aged, Neuroprotective Agents pharmacology, Neuroprotective Agents administration & dosage, Follow-Up Studies, Fingolimod Hydrochloride pharmacology, Fingolimod Hydrochloride therapeutic use, Fingolimod Hydrochloride administration & dosage, Natalizumab pharmacology, Natalizumab administration & dosage, Natalizumab therapeutic use, Multiple Sclerosis drug therapy, Multiple Sclerosis pathology, Multiple Sclerosis diagnostic imaging, Brain diagnostic imaging, Brain drug effects, Brain pathology, Magnetic Resonance Imaging, Atrophy, Immunologic Factors pharmacology, Immunologic Factors administration & dosage
- Abstract
Background: The long-term effect of high efficacy disease modifying therapy (DMT) on neurodegeneration in people with multiple sclerosis (pwMS) is largely unknown. The aim of this study was to evaluate the long-term effect of natalizumab (NTZ) or fingolimod (FTY) therapy on the evolution of brain atrophy compared to moderate efficacy DMT in a real-world clinical setting., Methods: A total of 438 pwMS with 2,439 MRI exams during treatment were analyzed: 252 pwMS treated with moderate efficacy DMT, 130 with NTZ and 56 with FTY. Evolution of brain atrophy was analyzed over an average follow-up of 6.6 years after treatment initiation. Brain segmentation was performed on clinical 3D-FLAIRs using SynthSeg and regional brain volume changes over time were compared between the treatment groups., Results: Total brain, white matter and deep gray matter atrophy rates did not differ between moderate efficacy DMTs, NTZ and FTY. Annualized ventricle growth rates were lower in pwMS treated with NTZ (1.1 %/year) compared with moderate efficacy DMT (2.4 %/year, p < 0.001) and similar to FTY (2.0 %/year, p = 0.051). Cortical atrophy rates were lower in NTZ (-0.08 %/year) compared with moderate efficacy DMT (-0.16 %/year, p = 0.048)., Conclusion: In a real-world clinical setting, pwMS treated with NTZ had slower ventricular expansion and cortical atrophy compared to those treated with moderate efficacy DMT., Competing Interests: Declaration of competing interest E.M.M. Strijbis, E.M.E. Coerver, Z.L.E. van Kempen and B. Jasperse have nothing to disclose. S. Noteboom is supported by research grants from Atara Biotherapeutics, Merck and Biogen. J. Killestein reports grants from Biogen, Novartis, TEVA, Bayer Schering Pharma, Glaxo Smith Kline, Merck, Genzyme and Roche. H. Vrenken has received research grants from Pfizer, Merck Serono, Novartis, and Teva, speaker honoraria from Novartis, and consulting fees from Merck Serono; all funds were paid directly to his institution. M.M. Schoonheim serves on the editorial board of Neurology and Frontiers in Neurology, receives research support from the Dutch MS Research Foundation, Eurostars-EUREKA, ARSEP, Amsterdam Neuroscience, MAGNIMS and ZonMW (Vidi grant, project number 09150172010056) and has served as a consultant for or received research support from Atara Biotherapeutics, Biogen, Celgene/Bristol Meyers Squibb, EIP, Sanofi, MedDay and Merck. M.D. Steenwijk is supported by research grants from Atara Biotherapeutics, Merck and Biogen., (Copyright © 2024. Published by Elsevier B.V.)
- Published
- 2024
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