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- Title
The Effect of Fingolimod on Conversion of Acute Gadolinium-Enhancing Lesions to Chronic T1 Hypointensities in Multiple Sclerosis.
- Authors
Oommen, Vinit V.; Tauhid, Shahamat; Healy, Brian C.; Chua, Alicia S.; Malik, Muhammad T.; Diaz‐Cruz, Camilo; Dupuy, Sheena L.; Weiner, Howard L.; Chitnis, Tanuja; Bakshi, Rohit
- Abstract
<bold>Background: </bold>Brain lesions converting to chronic T1 hypointensities ("chronic black holes" [CBH]), indicate severe tissue destruction (axonal loss and irreversible demyelination) in multiple sclerosis (MS). Two mechanisms by which fingolimod could limit MS lesion evolution include sequestration of lymphocytes in the periphery or direct neuroprotective effects. We investigated the effect of fingolimod on the evolution of acute gadolinium-enhancing (Gd+) brain lesions to CBH in patients with MS. <bold>Methods: </bold>This was a retrospective nonrandomized comparison of patients with Gd+ brain lesions at the time of starting oral fingolimod [.5 mg/day, n = 26, age (mean ± SD) 39.2 ± 10.6 years, Expanded Disability Status Scale (EDSS) score - median (range): 1.75 (0, 6.5)] to those on no therapy [n = 30, age 41.7 ± 9.3 years; EDSS 1.0 (0, 6)]. Each lesion was classified by whether it converted to a CBH in the year following treatment. <bold>Results: </bold>In the fingolimod group, 99 Gd+ baseline lesions (mean ± SD, range: 3.8 ± 5.1; 1, 21 per patient) were identified of which 25 (25%) evolved to CBH (1.0 ± 2.0; 0, 10 per patient). The untreated group had 62 baseline Gd+ lesions (2.1 ± 2.3; 1, 13), 26 (42%) of which evolved to CBH (.9 ± 1.4; 0, 7) (P = .063). Thirteen patients (50%) receiving fingolimod and 17 untreated patients (57%) developed CBH (P = .79). <bold>Conclusion: </bold>This pilot study shows a trend of fingolimod on reducing the conversion rate from acute to chronic destructive MS lesions. Such an effect awaits verification in larger randomized prospective studies.
- Subjects
FINGOLIMOD; MULTIPLE sclerosis; NEUROPROTECTIVE agents; DEMYELINATION; LYMPHOCYTES; BRAIN damage; BRAIN; CHEMICAL elements; COMPARATIVE studies; IMMUNOSUPPRESSIVE agents; MAGNETIC resonance imaging; RESEARCH methodology; MEDICAL cooperation; RESEARCH; PILOT projects; EVALUATION research; TREATMENT effectiveness; RETROSPECTIVE studies; PHARMACODYNAMICS
- Publication
Journal of Neuroimaging, 2016, Vol 26, Issue 2, p184
- ISSN
1051-2284
- Publication type
journal article
- DOI
10.1111/jon.12307