Background Reliable biomarkers for disability progression independent of relapse activity (PIRA) in multiple sclerosis (MS) applicable in routine patient care are urgently needed. This study reports results from an ongoing multicenter, prospective, observational study with the primary objective of investigating the association of change in brain MRI biomarkers and PIRA. Methods In total 453 active relapsing remitting patients from 19 sites with baseline (BL) and one-year follow-up (FU) visits were included. At each visit, medication, relapse activity, and EDSS were recorded. MRI included 3D-T1 and 2D/3D-FLAIR. BL and FU scans enabled extraction of new/enlarged T2-lesions and brain volume loss (BVL) (annualized). Correlations and logistic regression assessed associations between EDSS progression and BVL/year. Results At BL an EDSS (25%/50%/75%) of 1.5/2.0/2.5 and a time since first MS diagnosis of 2.1/5.7/11.4 years were observed. Change (FU-BL): ΔEDSS was 0.0/0.0/0.0, BVL/year was <InlineEquation ID="IEq1"> <InlineMediaObject> <ImageObject Color="BlackWhite" FileRef="415_2025_13343_Article_IEq1.gif" Format="GIF" Height="13" Rendition="HTML" Resolution="72" Type="Linedraw" Width="19" /> </InlineMediaObject> <EquationSource Format="TEX">$-$</EquationSource> <EquationSource Format="MATHML"><math> <mo>-</mo> </math></EquationSource> </InlineEquation>0.5/<InlineEquation ID="IEq2"> <InlineMediaObject> <ImageObject Color="BlackWhite" FileRef="415_2025_13343_Article_IEq1.gif" Format="GIF" Height="13" Rendition="HTML" Resolution="72" Type="Linedraw" Width="19" /> </InlineMediaObject> <EquationSource Format="TEX">$-$</EquationSource> <EquationSource Format="MATHML"><math> <mo>-</mo> </math></EquationSource> </InlineEquation>0.3/<InlineEquation ID="IEq3"> <InlineMediaObject> <ImageObject Color="BlackWhite" FileRef="415_2025_13343_Article_IEq1.gif" Format="GIF" Height="13" Rendition="HTML" Resolution="72" Type="Linedraw" Width="19" /> </InlineMediaObject> <EquationSource Format="TEX">$-$</EquationSource> <EquationSource Format="MATHML"><math> <mo>-</mo> </math></EquationSource> </InlineEquation>0.0%, age-adjusted BVL/year was <InlineEquation ID="IEq4"> <InlineMediaObject> <ImageObject Color="BlackWhite" FileRef="415_2025_13343_Article_IEq1.gif" Format="GIF" Height="13" Rendition="HTML" Resolution="72" Type="Linedraw" Width="19" /> </InlineMediaObject> <EquationSource Format="TEX">$-$</EquationSource> <EquationSource Format="MATHML"><math> <mo>-</mo> </math></EquationSource> </InlineEquation>0.4/<InlineEquation ID="IEq5"> <InlineMediaObject> <ImageObject Color="BlackWhite" FileRef="415_2025_13343_Article_IEq1.gif" Format="GIF" Height="13" Rendition="HTML" Resolution="72" Type="Linedraw" Width="19" /> </InlineMediaObject> <EquationSource Format="TEX">$-$</EquationSource> <EquationSource Format="MATHML"><math> <mo>-</mo> </math></EquationSource> </InlineEquation>0.1/0.2%, and number of new/enlarged T2-lesions per year was 0.0/0.0/0.6. 75% of patients were relapse activity-free during the observation period, 72% had no new/enlarged T2-lesions, and 56% were free of both. BVL/year (adjusted for age) correlated with ΔEDSS (r = <InlineEquation ID="IEq6"> <InlineMediaObject> <ImageObject Color="BlackWhite" FileRef="415_2025_13343_Article_IEq1.gif" Format="GIF" Height="13" Rendition="HTML" Resolution="72" Type="Linedraw" Width="19" /> </InlineMediaObject> <EquationSource Format="TEX">$-$</EquationSource> <EquationSource Format="MATHML"><math> <mo>-</mo> </math></EquationSource> </InlineEquation>0.14, p = 0.002) for all patients, but also for sub-cohorts of patients without new/enlarged T2-lesions and without relapses (r =<InlineEquation ID="IEq7"> <InlineMediaObject> <ImageObject Color="BlackWhite" FileRef="415_2025_13343_Article_IEq1.gif" Format="GIF" Height="13" Rendition="HTML" Resolution="72" Type="Linedraw" Width="19" /> </InlineMediaObject> <EquationSource Format="TEX">$-$</EquationSource> <EquationSource Format="MATHML"><math> <mo>-</mo> </math></EquationSource> </InlineEquation>0.17, p = 0.008). BVL/year was significantly associated with EDSS progression in the logistic regression model (p < 0.001). The risk of EDSS progression increases from 15% to 19% (relative risk increase of 26%), when BVL/year declines from <InlineEquation ID="IEq8"> <InlineMediaObject> <ImageObject Color="BlackWhite" FileRef="415_2025_13343_Article_IEq1.gif" Format="GIF" Height="13" Rendition="HTML" Resolution="72" Type="Linedraw" Width="19" /> </InlineMediaObject> <EquationSource Format="TEX">$-$</EquationSource> <EquationSource Format="MATHML"><math> <mo>-</mo> </math></EquationSource> </InlineEquation>0.5% to <InlineEquation ID="IEq9"> <InlineMediaObject> <ImageObject Color="BlackWhite" FileRef="415_2025_13343_Article_IEq1.gif" Format="GIF" Height="13" Rendition="HTML" Resolution="72" Type="Linedraw" Width="19" /> </InlineMediaObject> <EquationSource Format="TEX">$-$</EquationSource> <EquationSource Format="MATHML"><math> <mo>-</mo> </math></EquationSource> </InlineEquation>1.0%. Conclusions BVL over one year was significantly associated with EDSS progression in the absence of relapses or new lesions, confirming its value as a short-term risk marker for disability progression in MS.

Whole brain volume loss is associated with a short-term disability progression in relapse-activity free multiple sclerosis

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2025年10月21日

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Roland Opfer,
Lothar Spies,
Julia Krüger,
Thomas Buddenkotte,
Holger Roick,
Manda Jankovic,
Nicolaj Witt,
Sylke Domke,
Ralf Kubalek,
Gerd Reifschneider,
Jürgen Kunz,
Ilias Nastos,
Felicita Heidler,
George Trendelenburg,
Andreas Stockert,
Deborah K. Erhart,
Hayrettin Tumani,
Hagen H. Kitzler,
Tjalf Ziemssen

摘要

Background

Reliable biomarkers for disability progression independent of relapse activity (PIRA) in multiple sclerosis (MS) applicable in routine patient care are urgently needed. This study reports results from an ongoing multicenter, prospective, observational study with the primary objective of investigating the association of change in brain MRI biomarkers and PIRA.

Methods

In total 453 active relapsing remitting patients from 19 sites with baseline (BL) and one-year follow-up (FU) visits were included. At each visit, medication, relapse activity, and EDSS were recorded. MRI included 3D-T1 and 2D/3D-FLAIR. BL and FU scans enabled extraction of new/enlarged T2-lesions and brain volume loss (BVL) (annualized). Correlations and logistic regression assessed associations between EDSS progression and BVL/year.

Results

At BL an EDSS (25%/50%/75%) of 1.5/2.0/2.5 and a time since first MS diagnosis of 2.1/5.7/11.4 years were observed. Change (FU-BL): ΔEDSS was 0.0/0.0/0.0, BVL/year was $-$ $-$ 0.5/ $-$ $-$ 0.3/ $-$ $-$ 0.0%, age-adjusted BVL/year was $-$ $-$ 0.4/ $-$ $-$ 0.1/0.2%, and number of new/enlarged T2-lesions per year was 0.0/0.0/0.6. 75% of patients were relapse activity-free during the observation period, 72% had no new/enlarged T2-lesions, and 56% were free of both. BVL/year (adjusted for age) correlated with ΔEDSS (r = $-$ $-$ 0.14, p = 0.002) for all patients, but also for sub-cohorts of patients without new/enlarged T2-lesions and without relapses (r = $-$ $-$ 0.17, p = 0.008). BVL/year was significantly associated with EDSS progression in the logistic regression model (p < 0.001). The risk of EDSS progression increases from 15% to 19% (relative risk increase of 26%), when BVL/year declines from $-$ $-$ 0.5% to $-$ $-$ 1.0%.

Conclusions

BVL over one year was significantly associated with EDSS progression in the absence of relapses or new lesions, confirming its value as a short-term risk marker for disability progression in MS.