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Sustained disability improvement is associated with T1 lesion volume shrinkage in natalizumab-treated patients with multiple sclerosis
  1. Luca Prosperini1,2,
  2. Floriana De Angelis1,2,
  3. Rosanna De Angelis1,2,
  4. Fulvia Fanelli1,2,
  5. Carlo Pozzilli1,2
  1. 1Multiple Sclerosis Centre, S. Andrea Hospital, Rome, Italy
  2. 2Department of Neurology and Psychiatry, Sapienza University, Rome, Italy
  1. Correspondence to Dr Luca Prosperini, Department of Neurology and Psychiatry, Sapienza University, Viale dell'Università, Rome 30-00185, Italy; luca.prosperini{at}

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Sustained disability improvement was observed in about 30% of patients with multiple sclerosis (MS) treated with natalizumab (Tysabri, Biogen Idec, Cambridge, Massachusetts, USA), thus suggesting the occurrence of reversal of neurological dysfunction.1 In addition to its striking effect in suppressing contrast-enhancing lesions and new or enlarged T2-hyperintense lesions on MRI by 92% and 83%, respectively,2 natalizumab was also reported to induce a decrease in lesion volumes on T2-weighted and T1-weighted images by 9.4% and 23.5%, respectively, over a 24-month follow-up.3 Nevertheless, the relationship between sustained disability improvement and reduction in MRI lesion burden during treatment with natalizumab has not been elucidated yet.


We collected clinical and MRI data from 88 patients (58 women, 30 men) treated with natalizumab at the MS Center of S Andrea Hospital in Rome (Italy). Brain MRI scans were acquired using a 1.5T magnet (GE Signa Excite) within 4 weeks before natalizumab start (baseline) and after 6 and 24 months (±4 weeks) of treatment. Hyperintense lesion volume on post-gadolinium T1-weighted images (GD-LV), T2-weighted images (T2-LV), and hypointense lesion volumes on T1-weighted images (T1-LV), were measured using a local thresholding segmentation technique (Jim 5.0, Xinapse Systems, Leicester, UK). Regions of interest were identified by the agreement of two trained operators (FDA and RDA) unaware of clinical data.

Patients were divided into three groups according to changes in their disability status at the end of the 24-month follow-up versus baseline, as follows: (1) 6-month sustained reduction of ≥1-point in Expanded Disability Status Scale (EDSS) score; (2) stable or …

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  • Contributors LP: study design, data analysis and interpretation, manuscript drafting; FDA: MRI data collection and analyses, manuscript revising; RDA: MRI data collection and analyses; FF: clinical data collection, manuscript revising; CP: study design, data interpretation, manuscript revising.

  • Funding This research was supported by Biogen Idec.

  • Competing interests LP has received consulting fees from Merck Serono, Bayer Schering and Biogen Idec, and speaker honoraria from Biogen Idec, Teva and Novartis. CP has received consulting and lecture fees from Sanofi-Aventis, Biogen Idec, Bayer Schering, Merck Serono, and Novartis; he also received research funding from Sanofi-Aventis, Merck Serono, Bayer Schering and Novartis. FDA, RDA and FF have nothing to disclose.

  • Patient consent Obtained.

  • Ethics approval This study was conducted in accordance with the International Conference on Harmonization Guidelines of Good Clinical Practice and the Declaration of Helsinki. In no way did this study interfere in the Care received by patients. The Ethical Committee of Sapienza University (President Prof. Aldo Isidori, Viale del Policlinico, 155, 00161 Roma, tel. +39-6-4453395, fax +39-6-4455345) provided exemption of approval for post-authorisation observational studies. Each patient involved in this study signed an informed consent before collecting, storing and analysing individual data.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement An anonymised dataset is available as a supplementary file for readers.