Abstract Details

Title Effects of Fingolimod and Natalizumab on Brain T1/T2-Weighted and Magnetization Transfer Ratios: A 2-Year Study

Topic Multiple Sclerosis

Presentation(s) P1 - Poster Session 1 (12:00 PM-1:00 PM)

Poster/Presentation
Number 9-022

Objective To compare the effects of fingolimod and natalizumab on brain T1/T2-weighted ratio (T1T2r) and magnetization transfer ratio (MTR) in relapsing-remitting multiple sclerosis (RRMS) over two years of treatment.

Background Fingolimod and natalizumab are highly effective treatments for RRMS to reduce disease activity and progression of brain damage. However, comparative studies are limited. T1T2r and MTR have been proposed as MRI measures to quantify and monitor brain microstructural tissue abnormalities.

Design/Methods Fifty-five RRMS patients starting fingolimod (n=25) or natalizumab (n=30) underwent 3T brain scans at baseline (T0), month 6 (M6), year 1 (Y1) and year 2 (Y2). T1T2r and MTR maps from white matter (WM) lesions, normal-appearing (NA) WM and gray matter (GM) were estimated using in-house implemented methods and compared using linear mixed models.

Results No baseline between-group difference was found. At M6 vs T0, fingolimod-patients had increased lesional MTR (p=0.05), whereas natalizumab-group showed increased lesional MTR (p=0.008) and T1T2r (p=0.02), without between-group differences. At Y2 vs M6, lesional T1YT2r and MTR values stabilized in fingolimod-group, whereas T1T2r decreased in natalizumab-group (p=0.002). At M6 vs T0, both groups showed stable NAWM T1T2r and MTR, whereas at Y2 vs M6 fingolimod-patients showed higher NAWM T1T2r values (p=0.01), without between-group differences. At M6 vs T0, fingolimod-patients showed reduced GM T1T2r (p=0.04) (not significant at between-group comparison), which recovered at Y2 (p=0.04). Conversely, GM T1T2r and MTR were stable in natalizumab-patients. At Y2 vs T0, fingolimod-patients had increased lesional (p=0.002) and GM MTR (p<0.001); these measures were stable in natalizumab-group, with a higher increase of GM MTR in fingolimod-patients (p=0.02).

Conclusions Natalizumab promotes an early recovery of lesional damage and limits microstructural damage accumulation in normal-appearing brain tissue. Fingolimod enhances recovery of tissue damage that is visible 6 months after treatment start.

Authors/Disclosures
Maria A. Rocca (Neuroimaging Research Unit) PRESENTER	Maria Assunta Rocca has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Biogen, Bristol Myers Squibb, Eli Lilly, Janssen, Roche. Maria Assunta Rocca has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for AstraZaneca, Biogen, Bristol Myers Squibb, Bromatech, Celgene, Genzyme, Horizon Therapeutics Italy, Merck Serono SpA, Novartis, Roche, Sanofi and Teva. The institution of Maria Assunta Rocca has received research support from MS Society of Canada, the Italian Ministry of Health, the Italian Ministry of University and Research, and Fondazione Italiana Sclerosi Multipla.
Paolo Preziosa (Ospedale San Raffaele)	Mr. Preziosa has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Bristol Myers Squibb . Mr. Preziosa has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Sanofi Genzyme. Mr. Preziosa has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Novartis. Mr. Preziosa has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Roche. Mr. Preziosa has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Merck.
Loredana Storelli	Loredana Storelli has nothing to disclose.
Lucia Moiola, MD, PhD (Fondazione Centro San Raffaele)	Dr. Moiola has nothing to disclose.
	No disclosure on file
	No disclosure on file
Massimo Filippi, MD, FAAN (Ospedale San Raffaele, Neuroimaging Research Unit)	Dr. Filippi has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Alexion, Almirall, Biogen, Merck, Novartis, Roche, Sanofi. Dr. Filippi has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion, Biogen, Bristol-Myers Squibb, Merck, Novartis, Roche, Sanofi, Sanofi-Aventis, Sanofi-Genzyme, Takeda. Dr. Filippi has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Bayer, Biogen, Celgene, Chiesi Italia SpA, Eli Lilly, Genzyme, Janssen, Merck-Serono, Neopharmed Gentili, Novartis, Novo Nordisk, Roche, Sanofi, Takeda, and TEVA. Dr. Filippi has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Springer Nature. The institution of Dr. Filippi has received research support from Biogen Idec, Merck-Serono, Novartis, Roche, the Italian Ministry of Health, the Italian Ministry of University and Research, and Fondazione Italiana Sclerosi Multipla.