Association of Brain Atrophy With Disease Progression Independent of Relapse Activity in Patients With Relapsing Multiple Sclerosis

• DOI: 10.1001/jamaneurol.2022.1025
• Publication Date: 2022-05-16T16:01:56Z
• Authors: Alessandro Cagol; Sabine Schaedelin; Muhamed Barakovic; Pascal Benkert; Ramona-Alexandra ...; Reza Rahmanzadeh; Riccardo Galbusera; Po-Jui Lu; Matthias Weigel; Lester Melie-Garcia; Esther Ruberte; Nina Siebenborn; Marco Battaglini; Ernst-Wilhelm Radue; Özgür Yaldizli; Johanna Oechtering; Tim Sinnecker; Johannes Lorscheider; Bettina Fischer-B...; Stefanie Müller; Lutz Achtnichts; Jochen Vehoff; Giulio Disanto; Oliver Findling; Andrew Chan; Anke Salmen; Caroline Pot; Claire Bridel; Chiara Zecca; Tobias Derfuss; Johanna M. Lieb; Luca Remonda; Franca Wagner; Maria I. Vargas; Renaud Du Pasquier; Patrice H. Lalive; Emanuele Pravatà; Johannes Weber; Philippe C. Cattin; Claudio Gobbi; David Leppert; Ludwig Kappos; Jens Kuhle; Cristina Granziera
• Keywords: Cerebral atrophy

<h3>Importance</h3> The mechanisms driving neurodegeneration and brain atrophy in relapsing multiple sclerosis (RMS) are not completely understood. <h3>Objective</h3> To determine whether disability progression independent of relapse activity (PIRA) patients with RMS is associated accelerated tissue loss. <h3>Design, Setting, Participants</h3> In this observational, longitudinal cohort study median (IQR) follow-up 3.2 years (2.0-4.9), data were acquired from January 2012 to September 2019 a consortium tertiary university nonuniversity referral hospitals. Patients included if they had regular clinical at least 2 magnetic resonance imaging (MRI) scans suitable for volumetric analysis. Data analyzed between 2020 March 2021. <h3>Exposures</h3> According the evolution during entire observation, classified as those presenting (1) only, (2) PIRA episodes (3) mixed activity, or (4) stability. <h3>Main Outcomes Measures</h3> Mean difference annual percentage change (MD-APC) volume/cortical thickness groups, calculated after propensity score matching. Brain rates, their association variables interest, explored linear mixed-effect models. <h3>Results</h3> Included 1904 MRI 516 (67.4% female; mean [SD] age, 41.4 [11.1] years; [IQR] Expanded Disability Status Scale score, 2.0 [1.5-3.0]). Scans insufficient quality excluded (n = 19). Radiological inflammatory was increased rates several compartments, while an annualized rate linked deep gray matter (GM) volume When compared clinically stable patients, loss (MD-APC, −0.36; 95% CI, −0.60 −0.12;<i>P</i> .02), mainly driven by GM cerebral cortex. who presented whole −0.18; −0.34 −0.02;<i>P</i> .04) respect both cortex GM. No differences measured activity. <h3>Conclusions Relevance</h3> Our shows that exhibit atrophy, especially These results point need recognize insidious manifestations practice further evaluate treatment strategies trials.