Assessing brain atrophy rates in a large population of untreated multiple sclerosis subtypes

作者：De Stefano N^*; Giorgio A; Battaglini M; Rovaris M; Sormani M P; Barkhof F; Korteweg T; Enzinger C; Fazekas F; Calabrese M; Dinacci D; Tedeschi G; Gass A; Montalban X; Rovira A; Thompson A; Comi G; Miller D H; Filippi M

来源：Neurology, 2010, 74(23): 1868-1876.

DOI：10.1212/WNL.0b013e3181e24136

Objective: To assess the time course of brain atrophy and the difference across clinical subtypes in multiple sclerosis (MS).
Methods: The percent brain volume change (PBVC) was computed on existing longitudinal (2 time points) T1-weighted MRI from untreated (trial and nontrial) patients with MS. Patients (n = 963) were classified as clinically isolated syndromes suggestive of MS (CIS, 16%), relapsing-remitting (RR, 60%), secondary progressive (SP, 15%), and primary progressive (9%) MS. The median length of follow-up was 14 months (range 12-68).
Results: There was marked heterogeneity of the annualized PBVC (PBVC/y) across MS subtypes (p = 0.003), with higher PBVC/y in SP than in CIS (p = 0.003). However, this heterogeneity disappeared when data were corrected for the baseline normalized brain volume. When the MS population was divided into trial and nontrial subjects, the heterogeneity of PBVC/y across MS subtypes was present only in the second group, due to the higher PBVC/y values found in trial data in CIS (p = 0.01) and RR (p < 0.001). The estimation of the sample sizes required for demonstrating a reduction of brain atrophy in patients in a placebo-controlled trial showed that this was larger in patients with early MS than in those with the progressive forms of the disease.
Conclusions: This first large study in untreated patients with multiple sclerosis (MS) with different disease subtypes shows that brain atrophy proceeds relentlessly throughout the course of MS, with a rate that seems largely independent of the MS subtype, when adjusting for baseline brain volume. Neurology (R) 2010; 74: 1868-1876

• 出版日期2010-6-8