AUTHOR=Honce Justin M. , Nair Kavita V. , Hoyt Brian D. , Seale Rebecca A. , Sillau Stefan , Engebretson Eric , Schurr Brittany , Corboy John R. , Vollmer Timothy L. , Alvarez Enrique 

TITLE=Brain Atrophy Rates for Stable Multiple Sclerosis Patients on Long-Term Fingolimod versus Glatiramer Acetate

JOURNAL=Frontiers in Neurology

VOLUME=Volume 11 - 2020

YEAR=2020

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2020.01045

DOI=10.3389/fneur.2020.01045

ISSN=1664-2295

ABSTRACT=Background: Clinically stable multiple sclerosis (MS) patients on long-term therapy often have negligible acute inflammation on MRI. Brain atrophy may provide insight into subclinical disease progression in such populations. 
Objective: To compare brain atrophy for age- and gender-matched MS patients treated for >2 years with fingolimod (FTY) or glatiramer acetate (GA), examining brain volume, cognition, and patient reported outcomes(PROs). 
Methods: Stable relapsing-MS patients, age 18-60, on FTY or GA for >2 years were followed for two years. MRI brain and lesion volumes, cognitive measures, and PROs were collected at baseline and annually. 
Results: 44 FTY and 43 GA patients completed baseline and year 2 visits. There were no differences in age, gender, or education. Median EDSS was 2.0GA and 2.5FTY(p=0.22). Treatment duration was longer for GA, 6.50GA vs. 3.73FTY years (p<0.001). Baseline geometric mean T2LV were different, GA=1009.29 cm3 vs. FTY=2404.67 cm3(p=0.0071). Baseline brain volumes were similar, GA=1508 cm3 vs FTY=1489 cm3(p=0.2381). Annualized atrophy rates, adjusted for baseline and at mean baseline value, were GA=-0.2775% vs. FTY=-0.2967% (p=0.7979). There were no differences in cognitive measures or PROs. 
Conclusions: Stable MS patients on long-term treatment with FTY and GA have similar brain volume loss rates. Differences in baseline disease severity may suggest patients with more aggressive disease treated with FTY may achieve similar brain volume loss rates as patients with milder baseline disease on GA.