Article Figures & Data
Figures
- Fig 1.
Spatial extent of lowered FA (in blue) of white matter voxels in the TBSS skeleton (green) (X = 77, Y = 109, Z = 77) of patients treated with natalizumab (upper 2 rows) and those treated with IFNb/GA (lower 2 rows). Patients starting natalizumab had reduced FA in 56.8% (P < .05) of the WM skeleton at baseline and improved to 47.2% at month 12. Patients continuing IFNb/GA had reduced FA in 41.4% of the WM skeleton at baseline and 39.1% at month 12.
- Fig 2.
Spatial extent of increased MD (in red) in white matter voxels in the TBSS skeleton (green) (X = 101, Y = 109, Z = 77) of patients treated with natalizumab (upper 2 rows) and those treated with IFNb/GA (lower 2 rows). Patients starting natalizumab had increased MD in 54.3% (P < .05) of the WM skeleton at baseline and 55.7% at month 12. Patients continuing IFNb/GA had increased MD in 33.7% of the WM skeleton at baseline and 36.1% at month 12.
Tables
Patients with Natalizumab (n = 22) Patients with IFNb/GA (n = 17) Healthy Controls (n = 12) P Value MS therapy Starting natalizumab at baseline Continuing IFNb/GA at baseline NA Descriptives Age (yr) 37.2 ± 8.8 38.2 ± 5.0 35.1 ± 5.3 .492 Sex (male/female)b 9:13 8:9 3:9 .322 Educationc (mean) (range) 6.0 (4–7) 6.0 (5–7) 7.0 (5–7) .016e HADS-Ac (mean) (range) 6.0 (1–13) 6.6 (1–14) 4.8 (1–12) .369 HADS-Dc (mean) (range) 4.5 (0–18) 5.0 (0–12) 1.8 (0–10) .008e CIS-20c (mean) (range) 68.5 (14–125) 86 (31–114) 42.5 (17–85) .002e MS characteristics EDSSb,c 3.0 (1.5–6.5) 2.5 (1.0–6.5) NA .615 Disease duration since onset (yr) 8.3 ± 6.2 9.1 ± 5.2 NA .662 Prior IFNb/GA duration at baseline (yr) 2.9 ± 3.1 4.5 ± 4.0 NA .169 Volumes NGMV (L) 0.75 ± 0.04 0.73 ± 0.06 0.77 ± 0.04 .134 NWMV (L) 0.69 ± 0.04 0.69 ± 0.04 0.73 ± 0.03 .020e NBV (L) 1.44 ± 0.06 1.42 ± 0.08 1.50 ± 0.06 .025f T2 lesion volume (mL)d 6.2 (2.4–14.9) 4.9 (2.5–12.0) NA .281 Cognition z scores Symbol Digit Modalities Test −2.17 ± 0.92 −1.71 ± 1.13 0.00 ± 1.00 <.001e SPART-total recall −1.90 ± 1.94 −0.82 ± 1.83 0.00 ± 1.00 .021g SPART-delayed recall −1.42 ± 1.57 −0.80 ± 1.93 0.00 ± 1.00 .076 VLGT–immediate recall −1.33 ± 1.84 −1.66 ± 1.53 0.00 ± 1.00 .052 VLGT–short-term free recall −1.66 ± 1.89 −1.40 ± 1.64 0.00 ± 1.00 .068 VLGT–long-term free recall −1.65 ± 1.86 −1.48 ± 1.72 0.00 ± 1.00 .070 WLG–Animals −0.97 ± 0.73 −0.75 ± 0.81 0.00 ± 1.00 .019g WLG–Professions −1.69 ± 1.15 −1.79 ± 1.58 0.00 ± 1.00 .001e WLG–4 letter “M” words −0.81 ± 1.0 −0.85 ± 0.94 0.00 ± 1.00 .072 Digit Span Forward −0.62 ± 1.06 −0.29 ± 0.98 0.00 ± 1.00 .670 Digit Span Backward −0.96 ± 1.13 −0.05 ± 1.36 0.00 ± 1.00 .067 TMT–Letter-Number Switching −2.33 ± 2.45 −1.58 ± 2.08 0.00 ± 1.00 .059 Stroop-interference −0.28 ± 1.44 −0.63 ± 1.25 0.00 ± 1.00 .697 Average cognition −1.61 ± 0.73 −1.22 ± 1.01 0.00 ± 1.00 <.001e Note:—CIS-20 indicates Checklist for Individual Strength questionnaire; HADS, Hospital Anxiety and Depression Scale; A, Anxiety; D, Depression; SPART, Spatial Recall Task; NGMV, normalized gray matter volume; NWMV, normalized white matter volume; VLGT, Verbal Memory and Learning Task; WLG, Word List Generation; TMT, Trail-Making Test; L, liter; NA, not applicable.
↵a When normally distributed, a multivariate General Linear Model was used with age, sex, and education included as covariates; General Linear Model main effect P values are shown. Nonparametric testing was performed using the Kruskall-Wallis and post hoc Mann-Whitney tests. P values < .05 are considered significant.
↵b χ2 test.
↵c Median and range.
↵d Median and interquartile range.
↵e Significant in both patient groups compared with healthy controls.
↵f Only significant between patients receiving IFNb/GA and healthy controls.
↵g Only significant between patients receiving natalizumab and healthy controls.
Time Point Baseline Month 12 P Value Patients on natalizumab EDSS 3.0 (1.5–6.5) 3.0 (1.0–6.5) 1.0 HADS-A 6.0 (1–13) 6.0 (0–15) 1.0 HADS-D 4.5 (0–18) 2.0 (0–17) .012b CIS-20 68.5 (14–125) 62.0 (10–117) .036 Patients on IFNb/GA (n = 17) EDSS 2.5 (1.0–6.5) 3.0 (1.5–7.0) .006b HADS-A 7.0 (1–14) 5.0 (1–11) .609 HADS-D 5.0 (0–12) 3.0 (0–14) .855 CIS-20 86.0 (31–114) 81.0 (16–105) .177 Healthy controls (n = 12) HADS-A 3.5 (1–12) 2.5 (0–9) 1.0 HADS-D 1.0 (0–10) 0.0 (0–5) 1.0 CIS-20 42.5 (17–85) 52.0 (17–82) .744 Baseline Month 12 P Value Patients on natalizumab (n = 22) FA severity (z score) −0.67 ± 0.65 −0.59 ± 0.69 .02a MD severity (z score) 0.89 ± 0.92 0.93 ± 0.98 .81 AD severity (z score) 0.36 ± 0.40 0.43 ± 0.39 .34 RD severity (z score) 0.94 ± 1.00 0.94 ± 1.07 1.0 NGMV (L) 0.75 ± 0.04 0.75 ± 0.05 1.0 NWMV (L) 0.69 ± 0.04 0.67 ± 0.03 .008a NBV (L) 1.44 ± 0.06 1.42 ± 0.06 .036a T2 lesion volume (mL)b 6.2 (2.4–14.9) 6.9 (2.2–13.6) .644 Patients on IFNb/GA (n = 17) FA severity (z score) −0.64 ± 0.43 −0.67 ± 0.48 .94 MD severity (z score) 0.74 ± 0.58 0.78 ± 0.58 .64 AD severity (z score) 0.26 ± 0.35 0.26 ± 0.28 1.0 RD severity (z score) 0.82 ± 0.59 0.87 ± 0.62 .43 NGMV (L) 0.73 ± 0.06 0.74 ± 0.05 1.0 NWMV (L) 0.69 ± 0.04 0.67 ± 0.03 .004a NBV (L) 1.42 ± 0.08 1.41 ± 0.07 <.001a T2 lesion volume (mL)b 4.9 (0.25–12.0) 5.4 (0.28–13.3) .012a RCI Baseline–Month 12 Patients on Natalizumab Patients on IFNb/GA P Value Symbol Digit Modalities Test −0.02 ± 0.68 −0.04 ± 0.77 .993 SPART-total 0.18 ± 1.46 −0.49 ± 1.42 .432 SPART-delayed 0.54 ± 1.69 0.06 ± 1.99 .629 VLGT–immediate recall −0.67 ± 0.88 0.20 ± 1.03 .024a VLGT–short-term free recall −0.15 ± 1.01 0.06 ± 0.75 .575 VLGT–long-term free recall −0.21 ± 1.36 0.47 ± 0.84 .211 WLG–Animals 0.15 ± 0.90 −0.40 ± 0.81 .185 WLG–Professions −0.19 ± 0.88 0.04 ± 1.17 .835 WLG–4 letter “M” words −0.61 ± 0.88 −0.36 ± 1.08 .129 Digit Span Forward −0.01 ± 0.87 0.06 ± 0.85 .842 Digit Span Backward −0.31 ± 0.89 −0.34 ± 1.42 .572 TMT–Letter-Number Switching 0.41 ± 3.23 0.59 ± 2.91 .922 Stroop-interference −1.00 ± 2.14 −0.78 ± 1.63 .595 Note:—SPART indicates Spatial Recall Task; VLGT, Verbal Memory and Learning Task; WLG, Word List Generation; TMT, Trail-Making Test.
↵a A significant difference between the patient groups.
