Wednesday, 15 July 2015

The power of the drug is more than the brush?

Mattioli F, Stampatori C, Bellomi F, Scarpazza C, Capra R. Natalizumab Significantly Improves Cognitive Impairment over Three Years in MS: Pattern of Disability Progression and Preliminary MRI Findings. PLoS One. 2015;10(7):e0131803. doi: 10.1371/journal.pone.0131803. eCollection 2015

Previous studies reported that Multiple Sclerosis (MS) patients treated with natalizumab for one or two years exhibit a significant reduction in relapse rate and in cognitive impairment, but the long term effects on cognitive performance are unknown. This study aimed to evaluate the effects of natalizumab on cognitive impairment in a cohort of 24 consecutive patients with relapsing remitting MS treated for 3 years. The neuropsychological tests, as well as relapse number and EDSS, were assessed at baseline and yearly for three years. The impact on cortical atrophy was also considered in a subgroup of them, and are thus to be considered as preliminary. Results showed a significant reduction in the number of impaired neuropsychological tests after three years, a significant decrease in annualized relapse rate at each time points compared to baseline and a stable EDSS. In the neuropsychological assessment, a significant improvement in memory, attention and executive function test scores was detected. Preliminary MRI data show that, while GM volume did not change at 3 years, a significantly greater parahippocampal and prefrontal gray matter density was noticed, the former correlating with neuropsychological improvement in a memory test. This study showed that therapy with Natalizumab is helpful in improving cognitive performance, and is likely to have a protective role on grey matter, over a three years follow-up.

The inflammatory response causes damage to the white matter and some of this will be reflected by downstream damage to the grey matter as axons in the white matter cause the neurons in the grey matter to suffer. Likewise there is evidence that there is direct damage to the grey matter and B cell activity in the meninges surrounding the brain correlates with grey lesions and loss and loss of cognitive function. There is some evidence that natalizumab inhibits oligoclonal bands and this study implies it can inhibit grey matter damage. So in this study people taking tysabri did better in accumulating less cognitive decline and doing better in memory tests. This perhaps tells us that inflammation is the key problem in grey and white damage and not the other way round.

Will it affect progressive MS? We should know soon.

One wonders what will happen but we will see if paint brushes are better or whether pharma is the Dulux/Crown/Winsor & Newton (famous UK paint manufacturers) of saving brain.   


  1. Is there a natalizumab Ppms trial? If so do you have the details

    1. The ASCEND trial in SPMS should have just wait for the announcement to the stock market sometime soon....My prediction is it will be a failure and it will not stop SPMS

      Hope I am wrong, however someone said that when they go for infusions they meet people who are having infusions at the same time and some are progressing.

      The question is will it change the rate of trials it seems that the placebo group do better than expected meaning the trials aren't long enough or powered enough.

      We shall soon see

    2. Does the trial assume SPMS progresses at the same rate for all patients?


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