Contributions
Abstract: EP1764
Type: ePoster
Abstract Category: Therapy - disease modifying - 30 Tools for detecting therapeutic response
Background: Brain atrophy occurs in all clinical stages of untreated patients with MS and correlates with disability and cognition at a group level. In clinical trials, high efficacy therapies have shown to reduce rate of brain atrophy. However, brain volume is routinely not measured in normal clinical practice.
Aims: To measure global and regional brain volumes in a real life cohort of relapsing remitting (RRMS) and secondary progressive (SPMS) Finnish MS patients. To analyze the correlation of volume changes during 2-years follow-up with cognition and achievement of no evidence of disease activity (NEDA) status.
Patients and methods: Global and regional brain volumes was measured from 3D T1 brain magnetic resonance images (MRI) using a Siemens 3.0 Tesla scanner from 24 newly diagnosed RRMS patients 6 months after initiating disease modifying therapy (DMT), and from 36 SPMS patients. Correlation of volumes and volume changes with cognition and disability were analysed using Wilcoxon and Pearson tests with R Statistics. Baseline global brain volume was measured by Sienax and 2-year percentage of brain volume change (PBVC) using Siena. Regional brain volumes were measured by cNeuro (Combinostics Ltd, Finland) using an automated method. SDMT (symbol digit modalities test) was used for cognitive testing and expanded disability status scale (EDSS) for disability measurement. NEDA was determined by no relapses, no EDSS progression and no new/enlarging lesions of brain MRI.
Results: At baseline, mean global brain volumes in patients in RRMS and SPMS groups were 1509 and 1398 ml respectively (Wilcoxon p< 0.001). Baseline EDSS was 1.35 in RRMS and 4.61 in the SPMS patients (Wilcoxon p< 0.001). EDSS change in 2 years was 0.27 in the RRMS and 0.38 in the SPMS patients. EDSS progression was not significant in either group. There was a moderate correlation with baseline SDMT and thalamic (Pearson r=0.42) and hippocampal (Pearson r=0.38) volumes. Relative change of SDMT at 2 years correlated with thalamic volume change (Pearson r=-0.24). NEDA status from the treatment epoch of 6 months after DMT initiation to 2 years thereafter was reached in 35% of the RRMS patients. SDMT worsened in patients not reaching NEDA. PBVC at 2 years was greater in patients not reaching NEDA compared to those reaching NEDA (0.8% vs 0.5%).
Conclusions: Thalamic atrophy correlates with cognition in MS. Brain volume loss and cognitive deterioration are greater in patients not reaching NEDA.
Disclosure: The study was supported by an unrestricted research grant from Biogen Idec Finland to Turku University Hospital, Division of Clinical Neuroscience.
M Soilu-Hänninen has received honoraria for lectures, advisory boards or for serving as an investigator for clinical trials from Bayer, Biogen, Eisai, Novartis, Orion, Roche, Sanofi-Genzyme, Teva and UCB.
J Lötjönen is CSO and J Koikkalainen is an employee of Combinostics.
T. Paavilainen has received a lecture fee from Roche.
JO Rinne serves as a consultant neurologist for CRST (Clinical Research Services Turku). The other authors do not have disclosures.
Abstract: EP1764
Type: ePoster
Abstract Category: Therapy - disease modifying - 30 Tools for detecting therapeutic response
Background: Brain atrophy occurs in all clinical stages of untreated patients with MS and correlates with disability and cognition at a group level. In clinical trials, high efficacy therapies have shown to reduce rate of brain atrophy. However, brain volume is routinely not measured in normal clinical practice.
Aims: To measure global and regional brain volumes in a real life cohort of relapsing remitting (RRMS) and secondary progressive (SPMS) Finnish MS patients. To analyze the correlation of volume changes during 2-years follow-up with cognition and achievement of no evidence of disease activity (NEDA) status.
Patients and methods: Global and regional brain volumes was measured from 3D T1 brain magnetic resonance images (MRI) using a Siemens 3.0 Tesla scanner from 24 newly diagnosed RRMS patients 6 months after initiating disease modifying therapy (DMT), and from 36 SPMS patients. Correlation of volumes and volume changes with cognition and disability were analysed using Wilcoxon and Pearson tests with R Statistics. Baseline global brain volume was measured by Sienax and 2-year percentage of brain volume change (PBVC) using Siena. Regional brain volumes were measured by cNeuro (Combinostics Ltd, Finland) using an automated method. SDMT (symbol digit modalities test) was used for cognitive testing and expanded disability status scale (EDSS) for disability measurement. NEDA was determined by no relapses, no EDSS progression and no new/enlarging lesions of brain MRI.
Results: At baseline, mean global brain volumes in patients in RRMS and SPMS groups were 1509 and 1398 ml respectively (Wilcoxon p< 0.001). Baseline EDSS was 1.35 in RRMS and 4.61 in the SPMS patients (Wilcoxon p< 0.001). EDSS change in 2 years was 0.27 in the RRMS and 0.38 in the SPMS patients. EDSS progression was not significant in either group. There was a moderate correlation with baseline SDMT and thalamic (Pearson r=0.42) and hippocampal (Pearson r=0.38) volumes. Relative change of SDMT at 2 years correlated with thalamic volume change (Pearson r=-0.24). NEDA status from the treatment epoch of 6 months after DMT initiation to 2 years thereafter was reached in 35% of the RRMS patients. SDMT worsened in patients not reaching NEDA. PBVC at 2 years was greater in patients not reaching NEDA compared to those reaching NEDA (0.8% vs 0.5%).
Conclusions: Thalamic atrophy correlates with cognition in MS. Brain volume loss and cognitive deterioration are greater in patients not reaching NEDA.
Disclosure: The study was supported by an unrestricted research grant from Biogen Idec Finland to Turku University Hospital, Division of Clinical Neuroscience.
M Soilu-Hänninen has received honoraria for lectures, advisory boards or for serving as an investigator for clinical trials from Bayer, Biogen, Eisai, Novartis, Orion, Roche, Sanofi-Genzyme, Teva and UCB.
J Lötjönen is CSO and J Koikkalainen is an employee of Combinostics.
T. Paavilainen has received a lecture fee from Roche.
JO Rinne serves as a consultant neurologist for CRST (Clinical Research Services Turku). The other authors do not have disclosures.