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Original research
Evolution of atrophied T2 lesion volume in primary-progressive multiple sclerosis: results from the phase 3 ORATORIO study
  1. Robert Zivadinov1,2,
  2. Jinglan Pei3,
  3. David Clayton3,
  4. Donna E Goldman3,
  5. Ryan C Winger3,
  6. Mark S Cabatingan3,
  7. Michael G Dwyer1,2,
  8. Niels Bergsland1
  1. 1 Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
  2. 2 Center for Biomedical Imaging at Clinical Translational Science Institute, University at Buffalo, State University of New York, Buffalo, NY, USA
  3. 3 Genentech Inc, South San Francisco, CA, USA
  1. Correspondence to Dr Robert Zivadinov, Department of Neurology, University at Buffalo State University of New York, Buffalo, NY 14203, USA; Rzivadinov{at}bnac.net

Abstract

Background Atrophied T2-lesion volume (aT2-LV) is an exploratory imaging marker in multiple sclerosis (MS) reflecting the volume of lesions subsumed into cerebrospinal fluid (CSF).

Objective To investigate the effect of ocrelizumab (OCR) versus placebo (PBO) over 120 weeks on the accumulation of aT2-LV in a double-blind placebo-controlled (DBP) phase 3, primary-progressive (PP) MS study (ORATORIO; NCT01194570).

Methods This post-hoc, MRI-blinded analysis evaluated 732 PPMS randomised to OCR (488) or PBO (244). Atrophied T2-LV was calculated by overlaying baseline T2-lesion masks on follow-up CSF maps. Clinical data from DBP and open-label extension (OLE) periods were available. Treatment effect was evaluated by a mixed-effect model with repeated measures, while logistic regression explored the association of aT2-LV at week 120 and clinical outcomes in the OLE period.

Results OCR treatment significantly reduced accumulation of aT2-LV compared with PBO (319.4 mm3 vs 366.1 mm3, p=0.015) at 120 weeks. OCR showed superiority over PBO in reducing aT2-LV in patients who developed confirmed disability progression (CDP) during the DBP period at 12 (CDP12) and 24 (CDP24) weeks for the composite of Expanded Disability Status Scale (EDSS), Nine-Hole Peg Test and Timed 25-Foot Walk test. Accumulation of aT2-LV at week 120 was related to CDP12-EDSS (p=0.018) and CDP24-EDSS (p=0.022) in the OLE for the patients who were treated by PBO in the DBP only.

Conclusions OCR showed a significant effect of reducing the accumulation of aT2-LV in PPMS in the DBP period and was related to CDP-EDSS in OLE only in the PBO arm.

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Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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Footnotes

  • Contributors RZ: study concept and design; analysis and interpretation; critical revision of the manuscript for important intellectual content; study supervision. JP: analysis and interpretation; statistical analysis; critical revision of the manuscript for important intellectual content; study supervision. DC, DEG, RCW and MSC: analysis and interpretation; critical revision of the manuscript for important intellectual content. MGD and NB: analysis and interpretation; critical revision of the manuscript for important intellectual content. RZ is the study guarantor.

  • Funding The study was sponsored by F. Hoffman-La Roche Ltd (SL41913).

  • Competing interests RZ received personal compensation from Bristol Myers Squibb, EMD Serono, Sanofi, Mapi Pharma, Filterlex, Sana Biotechnologies, 3D Communications, 415 Capital for speaking and consultant fees. He received financial support for research activities from Bristol Myers Squibb, Novartis, CorEvitas, Mapi Pharma and Protembis. JP, DC, DCG, RCW and MSC are Genentech employees. MGD and NB have nothing to disclose.

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