Dynamics of pseudo-atrophy in RRMS reveals predominant gray matter compartmentalization.
Dynamics of pseudo-atrophy in RRMS reveals predominant gray matter compartmentalization.
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RRMS的假性萎缩动力学表现为明显的灰质分区。
DOI：
10.1002/acn3.51302
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发表时间：
2021-03
影响因子：
5.3
通讯作者：
Battaglini M
中科院分区：
文献类型：
--
作者：
De Stefano N;Giorgio A;Gentile G;Stromillo ML;Cortese R;Gasperini C;Visconti A;Sormani MP;Battaglini M
为了评估多发性硬化症(MS)患者在开始抗炎治疗后观察到的“假性萎缩”(即加速的脑体积损失)的动力学。比较接受干扰素β-1a(干扰素β-1a)治疗40周的复发缓解MS患者和接受安慰剂治疗(16周)和随后接受干扰素β-1a(24周)治疗的复发缓解MS患者的每月磁共振成像数据，以评估灰质(PGMVC)和白质(PWMVC)体积变化的百分比。用混合效应线性模型对PGMVC和PWMVC斜率进行了比较。在接受干扰素β-1a治疗的ARM中，模型中包括了一个二次项，以评估超过40周的平台期效果。截至第16周，安慰剂组的−为0.14%/月，治疗组为0.27%/月(P<0.001)。在同一时期，PWMVC的下降在安慰剂组为−0.067%/月，在治疗组为0.116%/月(P=0.27)。在开始干扰素β-1a治疗(第16-40周，可靠性分析)时，最初随机服用安慰剂的那一组也发现了类似的变化。在最初治疗的组中，在40周以上，PGMVC的下降显示出显著的(P<0.001)二次分量，表明在第20周处于平稳状态。这里报道的发现增加了对假性萎缩的复杂机制及其与MS患者GM中发生的区域化炎症的关系的新的见解。正在进行的和即将进行的临床试验，包括作为结果衡量标准的MRI衍生的GM体积丢失，需要考虑潜在的显着GM体积变化，作为初始治疗效果的一部分。
To assess the dynamics of “pseudo‐atrophy,” the accelerated brain volume loss observed after initiation of anti‐inflammatory therapies, in patients with multiple sclerosis (MS). Monthly magnetic resonance imaging (MRI) data of patients from the IMPROVE clinical study (NCT00441103) comparing relapsing‐remitting MS patients treated with interferon beta‐1a (IFNβ‐1a) for 40 weeks versus those receiving placebo (16 weeks) and then IFNβ‐1a (24 weeks) were used to assess percentage of gray (PGMVC) and white matter (PWMVC) volume changes. Comparisons of PGMVC and PWMVC slopes were performed with a mixed effect linear model. In the IFNβ‐1a‐treated arm, a quadratic term was included in the model to evaluate the plateauing effect over 40 weeks. Up to week 16, PGMVC was −0.14% per month in the placebo and −0.27% per month in treated patients (P < 0.001). Over the same period, the decrease in PWMVC was −0.067% per month in the placebo and −0.116% per month in treated patients (P = 0.27). Similar changes were found in the group originally randomized to placebo when starting IFNβ‐1a treatment (week 16–40, reliability analysis). In the originally treated group, over 40 weeks, the decrease in PGMVC showed a significant (P < 0.001) quadratic component, indicating a plateauing at week 20. Findings reported here add new insights into the complex mechanisms of pseudo‐atrophy and its relation to the compartmentalized inflammation occurring in the GM of MS patients. Ongoing and forthcoming clinical trials including MRI‐derived GM volume loss as an outcome measure need to account for potentially significant GM volume changes as part of the initial treatment effect.
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