Periventricular magnetisation transfer ratio abnormalities in multiple sclerosis improve after alemtuzumab.
Wheeler-Kingshott, Claudia Am Gandini
Multiple sclerosis (Houndmills, Basingstoke, England)
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Brown, W., Prados Carrasco, F., Eshaghi, A., Sudre, C. H., Button, T., Pardini, M., Samson, R. S., et al. (2020). Periventricular magnetisation transfer ratio abnormalities in multiple sclerosis improve after alemtuzumab.. Multiple sclerosis (Houndmills, Basingstoke, England), 26 (9), 1093-1101. https://doi.org/10.1177/1352458519852093
Background In MS, disease effects on magnetisation transfer ratio (MTR) increase towards the ventricles. This periventricular gradient is evident shortly after first symptoms and is independent of white matter lesions. Objective To explore if alemtuzumab, a peripherally-acting disease-modifying treatment, modifies the gradient’s evolution, and whether baseline gradients predict on-treatment relapses. Methods Thirty-four people with relapsing-remitting MS underwent annual MRI scanning (19 receiving alemtuzumab (4 scans each), 15 untreated (3 scans each)). The normal-appearing white matter was segmented into concentric bands. Gradients were measured over the three bands nearest the ventricles. Mixed-effects models adjusted for age, gender, relapse rate, lesion number and brain parenchymal fraction compared the groups’ baseline gradients and evolution. Results Untreated, the mean MTR gradient increased (+0.030pu/band/year) but decreased following alemtuzumab (-0.045pu/band/year, p=0.037). Within the alemtuzumab group there were no significant differences in baseline lesion number (p=0.568) nor brain parenchymal fraction (p=0.187) between those who relapsed within 4 years (n=4) and those who did not (n=15). However, the baseline gradient was significantly different (p=0.020). Conclusion Untreated, abnormal periventricular gradients worsen with time, but appear reversible with peripheral immunotherapy. Baseline gradients - but not lesion loads or brain volumes – may predict on-treatment relapses. Larger confirmatory studies are required.
WELLCOME TRUST (105924/Z/14/Z)
WELLCOME TRUST (105924/Z/14/A)
Wellcome Trust (105924/Z/14/Z)
Wellcome Trust (105924/Z/14/A)
External DOI: https://doi.org/10.1177/1352458519852093
This record's URL: https://www.repository.cam.ac.uk/handle/1810/292675
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