Summary: A new method using magnetic resonance imaging (MRI) from 1,889 participants from three separate multiple sclerosis (MS) phase III clinical trials were used to detect slowly expanding lesions as a marker for chronic active lesions. Chronic active lesions are more prominent in progressive MS than in relapsing forms of the disease and may have the potential to inform clinical prognosis of progressive MS patients.
Background: MRI is a medical imaging technique commonly used in radiology to visualize the internal function and structure of the body. In MS, the MRI can provide pictures of the areas of damage (lesions) in the central nervous system and can also reveal whether there is a loss of brain volume. While conventional MRI measures identify markers of acute inflammatory activity, it has not been shown to detect injury of chronic MS lesions which are characterized by lower levels of inflammation and are termed chronic active or “smoldering” lesions.
Objective: A research team, led by Dr. Doug Arnold, a world-renowned expert in MRI from McGill University, aimed to develop a method that could detect these slowly expanding lesions (SELs). The results were recently published in the Multiple Sclerosis Journal.
Methodology: Investigators used data from 1,334 patients with relapsing-remitting MS (RRMS) that participated in the OPERA I and OPERA II, and 555 patients with primary-progressive MS (PPMS) that participated in the ORATORIO phase III clinical trials. MRI from both trials was used to develop an algorithm based on longitudinal changes that could identify SELs.
The Results: Using the MRI images collected from the phase III clinical trial, the researchers found a high prevalence of SELs in both RRMS and PPMS participants. Interestingly, this method detected a higher number and volume of SELs in patients with PPMS rather than RRMS. SELs did not have gadolinium enhancement, commonly used in MRI to detect active inflammation.
Comment: The researchers developed a novel marker to detect SELs that has the potential to inform clinical prognosis of patients with progressive forms of MS.Additional research is needed to confirm that the detection of the number and volume of SELs is directly linked to MS prognosis.
In addition to this published research, Dr. Arnold has brought together a team of international interdisciplinary specialists with the goal of developing next-generation MRI markers of disease progression, which can be used in early-stage clinical trials for his project funded by the Progressive MS Alliance (PMSA). This research has the potential to have an impact on how clinicians diagnose progressive MS, monitor changes in disease, and assess treatment benefits.
Source:
Elliott C et al. (2018) Slowly expanding/evolving lesions as a magnetic resonance imaging marker of chronic active multiple sclerosis lesions. Multiple Sclerosis Journal. [Epub ahead of Print]