OBJECTIVE To compare the efficacy of fingolimod and natalizumab in preventing regional grey matter (GM) and white matter (WM) atrophy in relapsing-remitting multiple sclerosis (RRMS) over 2 years. METHODS Patients with RRMS starting fingolimod (n=25) or natalizumab (n=30) underwent clinical examination and 3T MRI scans at baseline (month (M) 0), M6, M12 and M24. Seventeen healthy controls were also scanned at M0 and M24. Tensor-based morphometry and SPM12 were used to assess the longitudinal regional GM/WM volume changes. RESULTS At M0, no clinical or GM/WM volume differences were found between treatment groups. At M24, both drugs reduced relapse rate (p<0.001 for both) and stabilised disability. At M6 vs M0, both groups experienced significant atrophy of several areas in the cortex, deep GM nuclei and supratentorial WM. Significant bilateral cerebellar GM and WM atrophy occurred in fingolimod patients only. At M12 vs M6 and M24 vs M12, further supratentorial GM and WM atrophy occurred in both groups. Bilateral GM/WM cerebellar atrophy continued to progress in fingolimod patients only. Compared with natalizumab, fingolimod-treated patients showed a significant cerebellar GM/WM atrophy, mainly at M6 vs M0, but still occurring up to M24. Compared with fingolimod, natalizumab-treated patients had a small number of areas of GM atrophy in temporo-occipital regions at the different time-points. CONCLUSIONS Natalizumab and fingolimod are associated with heterogeneous temporal and regional patterns of GM and WM atrophy progression. Compared with natalizumab, fingolimod-treated patients experience accelerated GM and WM atrophy in the cerebellum, while both drugs show minimal regional volumetric differences in supratentorial regions.

中文翻译：

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随着那他珠单抗和芬戈莫德的使用，两年区域灰白色物质的体积变化。

目的比较芬戈莫德和那他珠单抗在两年内预防复发性多发性硬化症（RRMS）中预防局部灰质（GM）和白质（WM）萎缩的疗效。方法对开始使用芬戈莫德（n = 25）或那他珠单抗（n = 30）的RRMS患者进行临床检查，并在基线（月（M）0），M6，M12和M24进行3T MRI扫描。还在M0和M24扫描了17个健康对照。基于张量的形态学和SPM12用于评估纵向区域GM / WM体积变化。结果在M0，治疗组之间没有发现临床或GM / WM体积差异。在M24时，两种药物均降低了复发率（两者均p <0.001）并稳定了残疾。在M6 vs M0，两组的皮质，深部GM核和幕上WM的多个区域均出现明显萎缩。仅芬戈莫德患者出现了严重的双侧小脑GM和WM萎缩。在M12对M6和M24对M12处，两组均发生进一步的幕上性GM和WM萎缩。仅芬戈莫德患者双侧GM / WM小脑萎缩持续发展。与那他珠单抗相比，芬戈莫德治疗的患者显示出明显的小脑GM / WM萎缩，主要发生在M6 vs M0，但仍出现到M24。与芬戈莫德相比，那他珠单抗治疗的患者在不同时间点的颞枕区域有少量的GM萎缩区域。结论纳他珠单抗和芬戈莫德与GM和WM萎缩进展的时间和区域模式异质相关。与那他珠单抗相比，芬戈莫德治疗的患者小脑GM和WM萎缩加快，