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CC BY 4.0 · Arq Neuropsiquiatr 2022; 80(07): 699-705
DOI: 10.1055/s-0042-1755277
Original Article

Brain volume loss and physical and cognitive impairment in naive multiple sclerosis patients treated with fingolimod: prospective cohort study in Buenos Aires, Argentina

Perda de volume cerebral e comprometimento físico e cognitivo em pacientes recém-diagnosticados com esclerose múltipla tratados com fingolimode: estudo de coorte prospectivo em Buenos Aires, Argentina
Juan Ignacio Rojas 
1   Multiple Sclerosis Center of Buenos Aires, Buenos Aires, Argentina.
2   Hospital Universitario CEMIC, Neurology Service, Buenos Aires, Argentina.
,
Liliana Patrucco 
3   Hospital Italiano de Buenos Aires, Neurology Service, Buenos Aires, Argentina.
,
Agustín Pappolla 
3   Hospital Italiano de Buenos Aires, Neurology Service, Buenos Aires, Argentina.
,
Francisco Sánchez 
1   Multiple Sclerosis Center of Buenos Aires, Buenos Aires, Argentina.
,
Edgardo Cristiano 
1   Multiple Sclerosis Center of Buenos Aires, Buenos Aires, Argentina.
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Abstract

Background The percentage of brain volume loss (PBVL) has been classically considered as a biomarker in multiple sclerosis (MS).

Objective The objective of the present study was to analyze if the PBVL during the 1st year after the onset of the disease predicts physical and cognitive impairment (CI).

Methods Prospective study that included naïve patients without cognitive impairment who initiated MS treatment with fingolimod. Patients were followed for 3 years and relapses, expanded disability status scale (EDSS) progression (defined as worsening of 1 point on the EDSS), the annual PBVL (evaluated by structural image evaluation using normalization of atrophy [SIENA]), and the presence of CI were evaluated. Cognitive impairment was defined in patients who scored at least 2 standard deviations (SDs) below controls on at least 2 domains. The PBVL after 1 year of treatment with fingolimod was used as an independent variable, while CI and EDSS progression at the 3rd year of follow-up as dependent variables.

Results A total of 71 patients were included, with a mean age of 35.4 ± 3 years old. At the 3rd year, 14% of the patients were classified as CI and 6.2% had EDSS progression. In the CI group, the PBVL during the 1st year was - 0.52 (±0.07) versus -0.42 (±0.04) in the no CI group (p < 0.01; odds ratio [OR] = 2.24; 95% confidence interval [CI]: 1.72–2.44). In the group that showed EDSS progression, the PBVL during the 1st year was - 0.59 (±0.05) versus - 0.42 (±0.03) (p < 0.01; OR = 2.33; 95%CI: 1.60–2.55).

Conclusions A higher PBVL during the 1st year in naïve MS patients was independently associated with a significant risk of CI and EDSS progression.

Resumo

Antecedentes A porcentagem de perda de volume cerebral (PPVC) é um biomarcador na esclerose múltipla (EM).

Objetivo Analisar se a PPVC durante o 1° ano após o início da doença prediz deterioração física (DF) e cognitiva (DC) em pacientes com EM.

Métodos Estudo de coorte prospectivo que incluiu pacientes recém-diagnosticados sem comprometimento cognitivo que iniciaram tratamento com fingolimode. Os pacientes foram acompanhados por 3 anos, sendo avaliados a presença de recidivas, progressão da Escala Expandida do Estado de Incapacidade (EDSS, na sigla em inglês) (definida como agravamento de 1 ponto na EDSS), o PPVC anual (avaliado pela avaliação de imagem estrutural de atrofia normalizada [SIENA, na sigla em inglês) e a presença de DC (avaliada no início do estudo e nos 2° e 3° anos). O PPVC no 1° ano de tratamento com fingolimode foi utilizado como variável independente.

Resultados foram incluídos 71 pacientes com idade média de 35,4 ± 3 anos. No 3° ano, 14% dos pacientes tiveram DC e 6,2% tiveram progressão de EDSS. No grupo DC, o PPVC durante o 1o ano foi - 0,52 (±0,07) versus - 0,42 (±0,04) no grupo sem DC (p < 0,01; razão de probabilidades [OR, na sigla em inglês] = 2,24; intervalo de confiança [IC] de 95%: 1,72–2,44). No grupo que apresentou progressão da EDSS, o PPVC durante o 1° ano foi de - 0,59 (±0,05) versus - 0,42 (±0,03) (p < 0,01; OR = 2,33; IC95%: 1,60–2,55).

Conclusões Um maior PPVC durante o 1° ano foi associado a um risco significativo de progressão de DC e EDSS durante o seguimento.

Keywords

Multiple Sclerosis - Cognitive Dysfunction - Disabled Persons - Biomarkers - Fingolimod Hydrochloride - Argentina

Palavras-chave

Esclerose Múltipla - Disfunção Cognitiva - Pessoas com Deficiências - Biomarcadores - Cloridrato de Fingolimode - Argentina

Authors' Contributions

JIR, LP: Data collection, data management, data analysis, and manuscript review; FS: Data collection, data management, and manuscript review; AP, EC: Data collection and manuscript review.


Support

The present research was funded by an educational grant from Novartis Argentina.




Publication History

Received: 16 September 2021

Accepted: 19 October 2021

Article published online:
29 September 2022

© 2022. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)

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