Journal of neurology, neurosurgery, and psychiatry · 2026
Biologic therapy and brain atrophy in neuromyelitis optica: a Japanese-German longitudinal MRI study.
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Masuda Hiroki, Anderhalten Lina, Mori Masahiro, Shiohama Tadashi, Maikusa Norihide, Hirano Shigeki, Uzawa Akiyuki, Muto Mayumi, Ohtani Ryohei, Uchida Tomohiko, Aoki Reiji, Kitagawa Hitomi, Hirano Yoshiyuki, Japanese Alzheimer’s Disease Neuroimaging Initiative (J-ADNI), Paul Friedemann, Kuwabara Satoshi
Аннотация
BACKGROUND: Differences in brain atrophy rates between patients with aquaporin-4 IgG-positive neuromyelitis optica spectrum disorder (AQP4Ab+NMOSD) and healthy controls (HCs), as well as the impact of biologic agents (BIO) on brain atrophy, have not been fully examined.
METHODS: In total, 72 patients with AQP4Ab+NMOSD identified at Chiba University Hospital or in the Berlin Registry of Neuroimmunological Entities (Chiba, 63; Berlin, 9) and 52 age-matched and sex-matched HCs (Chiba, 47; Berlin, 5) were included. Only patients without relapses between the baseline and follow-up MRI scans were included. Regional brain volumes were normalised to the intracranial volume. Patients who continuously used BIOs or non-BIO preventive treatments between the two MRI scans were assigned to the BIO or non-BIO subgroups, respectively. We applied a longitudinal combined association test to correct for MRI scanner differences.
RESULTS: Patient age and the interval between MRI scans did not differ between the groups. The NMOSD group exhibited a lower whole-brain volume than the HC group at follow-up (p<0.001) and a significantly higher whole-brain atrophy rate (p=0.009). Patients with smaller subcortical grey matter (SGM) volumes at follow-up MRI exhibited greater clinical disability (ρ = -0.27, p=0.022). In the BIO subgroup, early initiation of treatment (p=0.013) and a higher relative duration of BIO exposure (p=0.028) were associated with lower annualised SGM atrophy rates.
CONCLUSIONS: This study suggested progressive silent brain atrophy in patients with AQP4Ab+NMOSD and that early BIO initiation might prevent the progression of brain atrophy.
METHODS: In total, 72 patients with AQP4Ab+NMOSD identified at Chiba University Hospital or in the Berlin Registry of Neuroimmunological Entities (Chiba, 63; Berlin, 9) and 52 age-matched and sex-matched HCs (Chiba, 47; Berlin, 5) were included. Only patients without relapses between the baseline and follow-up MRI scans were included. Regional brain volumes were normalised to the intracranial volume. Patients who continuously used BIOs or non-BIO preventive treatments between the two MRI scans were assigned to the BIO or non-BIO subgroups, respectively. We applied a longitudinal combined association test to correct for MRI scanner differences.
RESULTS: Patient age and the interval between MRI scans did not differ between the groups. The NMOSD group exhibited a lower whole-brain volume than the HC group at follow-up (p<0.001) and a significantly higher whole-brain atrophy rate (p=0.009). Patients with smaller subcortical grey matter (SGM) volumes at follow-up MRI exhibited greater clinical disability (ρ = -0.27, p=0.022). In the BIO subgroup, early initiation of treatment (p=0.013) and a higher relative duration of BIO exposure (p=0.028) were associated with lower annualised SGM atrophy rates.
CONCLUSIONS: This study suggested progressive silent brain atrophy in patients with AQP4Ab+NMOSD and that early BIO initiation might prevent the progression of brain atrophy.