News | Neuro Imaging | August 30, 2018

Study Finds Multiple Sclerosis Drug Slows Brain Shrinkage

NIH-funded trial offers hope for disease with limited treatment options

Study Finds Multiple Sclerosis Drug Slows Brain Shrinkage

An NIH-funded clinical trial suggested that the anti-inflammatory drug ibudilast may slow brain shrinkage caused by progressive MS. Image courtesy of Robert J. Fox, M.D., Cleveland Clinic.

August 30, 2018 — Results from a clinical trial of more than 250 participants with progressive multiple sclerosis (MS) revealed the drug ibudilast was better than a placebo in slowing down brain shrinkage. The study also showed that the main side effects of ibudilast were gastrointestinal and headaches.

The study was supported by the National Institute of Neurological Disorders and Stroke (NINDS), part of the National Institutes of Health, and published in the New England Journal of Medicine.1

“These findings provide a glimmer of hope for people with a form of multiple sclerosis that causes long-term disability but does not have many treatment options,” said Walter J. Koroshetz, M.D., director of the NINDS.

MS occurs when there is a breakdown of myelin, a fatty white substance wrapped around axons, which are long strands that carry messages from and between brain cells. When myelin starts to break down, communication between brain cells slows down, leading to muscle weakness and problems with movement, balance, sensation and vision. MS can be relapsing-remitting, in which symptoms occur then disappear for weeks or months and then may reappear, or progressive, which is marked by a gradual decline in function.

Robert J. Fox, M.D., a neurologist at Cleveland Clinic in Ohio, led a team of researchers across 28 clinical sites in a brain imaging study. They were investigating whether ibudilast was better than placebo in reducing the progression of brain atrophy, or shrinkage, in patients with progressive multiple sclerosis.

In the study, 255 patients were randomized to take up to 10 capsules of ibudilast or placebo per day for 96 weeks. Every six months, the participants underwent magnetic resonance imaging (MRI) brain scans. Fox’s team applied a variety of analysis techniques on the MRI images to assess differences in brain changes between the two groups.

The study showed that ibudilast slowed down the rate of brain atrophy compared to placebo. Fox and his colleagues discovered that there was a difference in brain shrinkage of 0.0009 units of atrophy per year between the two groups, which translates to approximately 2.5 milliliters of brain tissue. In other words, although both groups experienced atrophy, the brains of the patients in the placebo group shrank on average 2.5 milliliters more over two years compared to the ibudilast group. The whole adult human brain has a volume of approximately 1,350 milliliters. However, it is unknown whether that difference had an effect on symptoms or loss of function.

There was no significant difference between the groups in the number of patients who reported adverse effects. The most common side effects associated with ibudilast were gastrointestinal, including nausea and diarrhea, as well as headaches and depression.  

“The trial’s results are very encouraging and point towards a potential new therapy to help people with progressive MS,” said Fox. “It also increased our understanding of advanced imaging techniques, so that future studies may require a smaller number of patients followed over a shorter period of time. This leads to increased efficiency of clinical research. These imaging methods may also be relevant to a host of other neurological disorders.”

Future research will test whether reducing brain shrinkage affects thinking, walking and other problems in people with MS. In addition, future studies will examine whether ibudilast slows the progression of disability in MS patients.  

For more information: www.nejm.org

Reference

1. Fox R.J., Coffey C.S., Conwit R., et al. Phase 2 Trial of Ibudilast in Progressive Multiple Sclerosis. New England Journal of Medicine, Aug. 30, 2018. DOI: 10.1056/NEJMoa1803583

 

Related Content

Imaging Biometrics and Medical College of Wisconsin Awarded NIH Grant
News | Neuro Imaging | September 09, 2019
Imaging Biometrics LLC (IB), in collaboration with the Medical College of Wisconsin (MCW), has received a $2.75 million...
ASNC Announces Multisocietal Cardiac Amyloidosis Imaging Consensus
News | Cardiac Imaging | September 09, 2019
September 9, 2019 — The American Society of Nuclear Cardiology (ASNC) published a new expert consensus document along
AJR Publishes Gender Affirmation Surgery Primer for Radiologists. transgender radiology images,

Scout image from contrast-enhanced CT shows erectile implant; stainless steel and silicone anchors (arrow) transfixed to pubic bone are asymmetric.

News | Orthopedic Imaging | September 05, 2019
September 5, 2019 — An ahead-of-print article published in the December issue of the American Journal of Roentgen
Neurological Brain Markers Might Detect Risk for Psychotic Disorders

Researchers at the University of Missouri used MRI scans similar to this photo to find neurological markers in the human brain. These markers can be used to detect people at risk for developing psychotic disorders and to understand when this risk has been successfully treated. Image courtesy of Marquette University/John Kerns.

News | Neuro Imaging | September 04, 2019
Help may be on the way for people who might lose contact with reality through a psychotic disorder, such as...
Medical Imaging Rates Continue to Rise Despite Push to Reduce Their Use
News | Radiology Imaging | September 03, 2019
Despite a broad campaign among physician groups to reduce the amount of medical imaging, use rates of various scans...
News | Contrast Media | September 03, 2019
Researchers in South Korea have found that patients with family and personal history of allergic reactions to contrast...
High-capacity MRI Scanner Approvals Boosting Innovations in MRI-safe Pulse Oximeters
News | Magnetic Resonance Imaging (MRI) | August 29, 2019
A notable increase in the prevalence of chronic diseases has led to a surge in sales of high-end diagnostic machines,...
An example of a treatment plan for radio-ablation of the heart to noninvasively treat cardiac arrhythmias. This concept is one of the key presentations at the 2019 ASTRO meeting. Image courtesy of Cyberheart. #ASTRO19 #ASTRO2019 #ASTRO

An example of a treatment plan for radio-ablation of the heart to noninvasively treat cardiac arrhythmias. This concept is one of the key presentations at the 2019 ASTRO meeting. Image courtesy of Cyberheart.

Feature | ASTRO | August 29, 2019
Delaware Imaging Network Now Offers NeuroQuant Brain Imaging MRI Software
News | Neuro Imaging | August 29, 2019
Delaware Imaging Network (DIN), Delaware’s largest network of outpatient medical imaging centers, has added NeuroQuant...
Displacement comparison at the end-systolic frame and final frame

Displacement comparison at the end-systolic frame and final frame. The three patients (V6, V10, V16) with different left-ventricle walls are shown. Point-to-surface distance is a measure to estimate the distance of a point from the reference surface. Image courtesy of WMG, University of Warwick

News | Cardiac Imaging | August 28, 2019
A new 3-D magnetic resonance imaging (MRI) computing technique developed by scientists in WMG at the University of...