Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Brain Volume Loss as Therapeutic Response Marker

JAMA Neurology; ePub 2018 Jul 2; Andorra, et al

Before using brain volume loss (BVL) as a marker of therapeutic response in multiple sclerosis (MS), certain biological and methodological issues must be clarified. This according to a recent study that assessed the dynamics of BVL as MS progresses and evaluated the repeatability and exchangeability of BVL estimates. A cohort of patients (n=140) who had either clinically isolated syndrome or MS underwent a series of annual MRI scans. Images from 2 cohorts of healthy volunteers were used to evaluate short-term repeatability of the MRI measurements (n=34) and annual BVL (n=20). Researchers found:

  • The BVL rates were higher in the first 5 years after MS onset with a direct association with steroids and an inverse association with age at MS onset, particularly in the first 5 years.
  • Considering an expected loss of 0.5% to 1.35% per year, the poor repeatability of 2 separate imaging methods prevents their use at the individual level; also, volumetric estimates and the accuracy of thresholds to discriminate patients with MS from healthy volunteers differ in the 2 approaches.
Citation:

Andorra M, Nakamura K, Lampert EJ, et al. Assessing biological and methodological aspects of brain volume loss in multiple sclerosis. [Published online ahead of print July 2, 2018]. JAMA Neurology. doi:10.1001/jamaneurol.2018.1596.

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