New acute and chronic black holes in patients with multiple sclerosis randomised to interferon beta-1b or glatiramer acetate.
BACKGROUND
Hypointense lesions on T1 weighted MRI, referred to as black holes (BH), are a marker of demyelination/axonal loss in multiple sclerosis (MS). There is some evidence that glatiramer acetate (GA) may decrease the conversion of new brain lesions to BH.


METHODS
Monthly 3-Tesla brain MRI scans were used for up to 2 years to study the development and evolution of new BH in 75 patients with MS randomised to GA or Interferon beta-1b (IFNbeta1b) in the BECOME study.


RESULTS
Of 1224 newly enhancing lesions (NEL) appearing at baseline through 24 months in 61 patients, 767 (62.7%) showed an acute BH (ABH). The majority of ABH were transient and of similar duration by treatment group. Of 571 ABH in which MRI follow-up scans were available for >or=1 year, 103 (18.8%) were still visible >or=12 months after onset and were considered chronic BH (CBH). Only 12.1% of the 849 NEL with MRI follow-up >or=1 year converted to CBH, 9.8% with IFNbeta1b and 15.2% with GA (p = 0.02). The conversion from ABH to CBH was also lower with IFNbeta1b (15.2%) than with GA (21.4%), of borderline significance (p = 0.06). The majority of patients who developed NEL did not develop CBH; however, about a quarter had conversion rates from ABH to CBH greater than 20%.


CONCLUSIONS
Only a minority of new brain lesions in patients with MS treated with GA or IFNbeta1b convert to CBH.
Cadavid
D
D
Department of Neurology and Neuroscience, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, Newark, New Jersey, USA. cadavidi@umdnj.edu
Cheriyan
J
J
Skurnick
J
J
Lincoln
J A
JA
Wolansky
L J
LJ
Cook
S D
SD
D000276:Adjuvants, Immunologic / Q000627:therapeutic use*; D001921:Brain / Q000187:drug effects / Q000473:pathology*; D000068717:Glatiramer Acetate; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D000068576:Interferon beta-1b; D016899:Interferon-beta / Q000627:therapeutic use*; D008279:Magnetic Resonance Imaging; D009103:Multiple Sclerosis / Q000188:drug therapy* / Q000473:pathology; D010455:Peptides / Q000627:therapeutic use*; D013997:Time Factors
D000276:Adjuvants, Immunologic; D007166:Immunosuppressive Agents; D010455:Peptides; D000068576:Interferon beta-1b; D000068717:Glatiramer Acetate; D016899:Interferon-beta