ECTRIMS 2025 | The effect of DMTs on brain volume loss and disability accumulation in MS

This was a study that we have recently published, and it’s basically a systematic review of the literature focusing on clinical trials that evaluated approved disease-modifying therapies for multiple sclerosis, including both relapsing multiple sclerosis and progressive multiple sclerosis. And we used as outcome measures, we explored the outcome measures of brain volume loss, so the effect of the treatments on brain volume loss, the effect of the treatment on disability accumulation and the effect of the treatments on lesion accumulation. And what was basically the hypothesis of the work was to detect whether there was an association between the effect of the different treatments on brain volume loss and the effect of the treatment on disability accumulation. So the first part of the study was basically to compare the efficacy of the different treatments that are approved for the treatment of multiple sclerosis, in terms of their efficacy in reducing brain volume loss. What we conducted was a network meta-analysis that basically allows and enables the comparisons of different treatments, even in the absence of direct clinical evidence, so direct evidence from clinical trials, even in the absence of head-to-head comparisons. So in this case, what we used was a common comparator, which in our case was placebo, and we ranked the efficacy of different treatments, of all the different treatments, as compared to placebo. And then what we did was to also explore whether this efficacy that we see. So for several treatments, we indeed find an effective impact on brain volume loss. So a positive impact in reducing brain volume loss over time. The second step was to see whether this efficacy on brain volume loss was also associated with an impact on disability accumulation. And this was explored by using a meta-regression approach where indeed we found a significant association between the treatment effect on brain volume loss and the treatment effect on disability accumulation. Therefore, it suggested that indeed brain volume loss is a useful biomarker to monitor a clinically relevant impact on the disease trajectories. And importantly, these associations remain also independently of the treatment effect on focal inflammatory activity. Therefore, indeed implying that we are able to a certain extent look at brain volume loss to characterize neurodegenerative processes that are indeed partially independent from the accumulation of new lesions and clinically meaningful.

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