Ricerc@Sapienza

Brain atrophy reflects the most destructive pathological processes, including tissue loss, neuronal damage and neurodegeneration. Neurodegeneration is a relevant hallmark of multiple sclerosis (MS), one of the most disabling neurological diseases in young adults. Measurements of percent brain volume change per year (PBVC/y) by magnetic resonance imaging (MRI) represent one of the best methods for evaluating neurodegeneration progression in MS. Many progresses have been made in drug therapy in MS, and a variety of disease-modifying drugs (DMDs) are now available. Clinical trials have shown a significant relationship between treatment effect on both brain atrophy and disability progression. However, despite of the proved efficacy of DMDs used as first-line treatment, many patients continue to experience `break- through disease¿, measured in term of either clinical or MRI activity, while being under treatment. In clinical practice, neurologists currently use different approach to manage breakthrough disease, including the switching between different classes of DMDs. During the last years, an escalation approach (switching to a more powerful drug) has demonstrated better outcomes (reduction of both clinical relapses and new MRI lesions). We aim at studying the effect of switching from a treatment to another on brain atrophy in a real-world study, in order to assess the "effectiveness" of switching treatments in routine clinical circumstances.
From a large dataset of MS patients (Italian Neuroimaging Network Initiative, INNI) containing MRI, clinical and therapeutic information, we will select those patients who switched from a first to a second drug and having MRI data available for at least three time points: at least 12 months before the switch to a second drug, at the start of the second drug and at least 12 months after the switch. The PBVC/y under different DMDs in each patient will be correlated with the clinical data obtained before and after the switching.