Keio University School of Medicine
Orthopedic Surgery

Author Of 1 Presentation

Imaging Poster Presentation

P0621 - q-Space Myelin Map imaging for longitudinal analysis of remyelination in multiple sclerosis patients treated with dimethyl fumarate (ID 334)

Speakers
Presentation Number
P0621
Presentation Topic
Imaging

Abstract

Background

[Background]

Multiple sclerosis (MS) is a demyelinating disease of the central nervous system (CNS). However, there is a lack of appropriate methods to monitor CNS myelin in daily practice. We successfully developed a novel imaging method, titled q-space Myelin Map (qMM). The qMM accurately depicted myelin status in a pilot clinical study of patients with MS, suggesting that it may be useful in detecting remyelinated lesions.

Dimethyl fumarate (DMF) has demonstrated its sustained efficacy on relapses and disability progression in patients with relapsing-remitting MS (RRMS). However, limited reports exist to indicate the potential for remyelination with DMF.

Objectives

[Objective]

To report the interim results of the efficacy of DMF on qMM recovery, which suggests remyelination activity, in patients with RRMS.

Methods

[Methods]

Nineteen RRMS patients were registered and 14 of those were evaluated as of February 2020. After initiating DMF, a longitudinal analysis of qMM was performed with 3-12 month intervals to detect q-MM supported remyelination and demyelination. The expanded disability status scale (EDSS) assessment and the qMM analysis were performed independently by board-certified neurologists. The study was approved in advance by the ethics committee of Keio University School of Medicine (#20170311).

Results

[Results]

A total of 14 patients were included in the analysis. The age and EDSS at baseline (mean ± standard deviation) were 37.6±10.2 years and 1.9±1.5, respectively. Prior disease-modifying therapies included glatiramer acetate (n=1), fingolimod (n=10) and natalizumab (n=1); two patients were treatment-naïve. Mean time to start DMF after MS onset was 80.1±95.9 months and DMF treatment duration was 23.1±9.4 months. Three patients discontinued DMF: reasons were disability progression (n=1), new MRI lesion (n=1) and entry of another clinical trial (n=1). One patient interrupted DMF due to pregnancy (n=1). Out of the 14 patients, 6 (42.9%) had presence of remyelination. Of those 6 patients, 3 had presence of remyelination only while 3 also had presence of demyelination. No patients were detected with demyelination only. In all 6 cases of remyelination, the remyelination was detected in the first year of DMF treatment.

Conclusions

[Conclusions]

The qMM successfully visualized remyelination activity in MS patients treated with DMF. The association between qMM-supported remyelination and disease progression should be further investigated in a larger population.

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