Ocrelizumab reduces cortical and deep grey matter loss compared to the S1P-receptor modulator in multiple sclerosis, Bajrami et. al., 2024

Summary

This study compared the effects of Ocrelizumab (OCR) and Fingolimod (FGL) on multiple sclerosis (MS) patients, focusing on their impact on cortical and deep grey matter atrophy. The findings indicate that OCR was more effective in reducing the number of new white matter lesions and slowing down the loss of deep grey matter volume compared to FGL. This suggests that early and targeted treatment with OCR could significantly help in mitigating the neurodegenerative components of MS, potentially leading to better long-term outcomes for patients.

 

Published in

Journal of Neurology

 

Authors

A. Bajrami, A. Tamanti, A. Peloso, S. Ziccardi, M. Guandalini, M. Calderone, M. Catellaro, F. B. Pizzini, S. Montemezzi, D. Marastoni, M. Calabrese

 

Summary

This study compared the effects of Ocrelizumab (OCR) and Fingolimod (FGL) on multiple sclerosis (MS) patients, focusing on their impact on cortical and deep grey matter atrophy. The findings indicate that OCR was more effective in reducing the number of new white matter lesions and slowing down the loss of deep grey matter volume compared to FGL. This suggests that early and targeted treatment with OCR could significantly help in mitigating the neurodegenerative components of MS, potentially leading to better long-term outcomes for patients. 

 

Abstract

Introduction

Ocrelizumab (OCR) and Fingolimod (FGL) are two high-efficacy treatments in multiple sclerosis which, besides their strong anti-inflammatory activity, may limit neurodegeneration.

 

Aim:

To compare the effect of OCR and FGL on clinical and MRI endpoints.

Methods:

95 relapsing–remitting patients (57 OCR, 38 FGL) clinically followed for 36 months underwent a 3-Tesla MRI at baseline and after 24 months. The annualized relapse rate, EDSS, new cortical/white matter lesions and regional cortical and deep grey matter volume loss were evaluated.

 

Results:

OCR reduced the relapse rate from 0.48 to 0.04, FGL from 0.32 to 0.05 (both p < 0.001). Compared to FGL, OCR-group experienced fewer new white matter lesions (12% vs 32%, p = 0.005), no differences in new cortical lesions, lower deep grey matter volume loss (− 0.12% vs − 0.66%; p = 0.002, Cohen’s d = 0.54), lower global cortical thickness change (− 0.45% vs − 0.70%; p = 0.036; d = 0.42) and reduced cortical thinning/volume loss in several regions of interests, including those of parietal gyrus (d-range = 0.65–0.71), frontal gyrus (d-range = 0.47–0.60), cingulate (d-range = 0.41–0.72), insula (d = 0.36), cerebellum (cortex d = 0.72, white matter d = 0.44), putamen (d = 0.35) and thalamus (d = 0.31). The effect on some regional thickness changes was confirmed in patients without focal lesions.

 

Conclusion:

When compared with FGL, patients receiving OCR showed greater suppression of focal MRI lesions accumulation and lower cortical and deep grey matter volume loss.

 

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