Monday, 15 April 2013

Daclizumab reduces brain shrinkage

#MSBlog #MSResearch An interesting glimpse into the mode of action of daclizumab; it may be neuroprotective.

Borges IT et al. The effect of daclizumab on brain atrophy in relapsing-remitting multiple sclerosis. Multiple Sclerosis and Related Disorders Volume 2, Issue 2 , Pages 133-140, April 2013

Background: Daclizumab is a monoclonal antibody that reduces inflammation in MS. 

Objective: Through a retrospective analysis, the objective of this study was to determine whether daclizumab treatment reduces the rate of brain structure atrophy in comparison to a mixture of other disease-modifying therapies (mainly different interferon β preparations). 

Method: The investigators analyzed MRI examinations (1332 scans from 70 MSers) obtained between 2000 and 2011 in a single centre and processed with an automated brain segmentation method. They determined whether a median of 4.3 years of daclizumab therapy in 26 MSers altered rates of brain-volume change, controlling for variations in MRI protocol. The control group consisted of 44 MSers not treated with daclizumab. 

Results: They found that supratentorial brain volume declined by 5.17ml per year (95% confidence limits: 3.58–6.77) off daclizumab therapy. On daclizumab, the annual rate of volume loss decreased to 3.72ml (p=0.01). The rate of ventricular enlargement decreased from 1.26 to 0.42ml per year (p<0.001). Focused analysis suggests that reduction in gray matter atrophy rate most likely underlies these results. 

Conclusions: In summary, in this retrospective analysis, daclizumab therapy substantially decreased the rate of brain atrophy in relapsing-remitting MS in comparison to other disease-modifying therapies, predominantly interferon β.

 

"Daclizumab is an antibody that blocks the interleukin-2 (a T-cell growth factor) receptor and influences natural killer cell function. This treatment inhibits relapsing disease and appears to slow the process that causes brain shrinkage. These data suggest that daclizumab is neuroprotective. Whether this neuroprotection is over and above daclizumab's effect on inflammation needs to be tested. These results are consistent with the clinical results I presented recently at the AAN in San Diego. I am very excited by the Daclizumab results and think this drug needs to be tested in SPMS and possibly PPMS."



CoI: multiple

5 comments:

  1. Dr Giovannoni, I wonder if you have any inkling as to how daclizumab compares with alemtuzumab as far as disability progression and atrophy go? I understand that it's probably very difficult to tell given that they haven't been/are unlikely to be ever tested head to head.

    Thanks

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    1. Too early to tell. We need to wait for the phase 3 Daclizumab results. Sorry I can be of more help; we simply don't have data to make any comparisons.

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  2. I met with a new neurologist who will take responsibility for MS patients and he was really interested in this blog after I wowed her with my knowledge of monoclonal antibodies, informing her of the differences between CD19 and CD20 monoclonal antibody treatments. I got all my knowledge from this blog. Even the junior doctor shadowing her was beaming at my understanding of research, Thanks guys.

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    Replies
    1. Thanks, it is always nice to get positive feedback.

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