Objective: To identify MRI markers that are associated with more rapid clinical progression in multiple system atrophy (MSA)

Background: The rate of clinical progression in patients with MSA varies between individuals and predictors for disease progression remain largely undefined. While the Rasagiline for MSA study found no difference in the rates of clinical progression for patients treated with rasagiline versus placebo, it offers a valuable source of trial data. It included a large, prospective magnetic resonance imaging (MRI) substudy that can provide new information on the underlying disease progression in patients with early MSA. 

Methods: This post-hoc analysis compared the rate of clinical progression in patients with MSA-specific structural changes at baseline (MRI-positive group) versus the rate of progression in patients without evidence of such changes at baseline (MRI-negative group). Clinical progression was assessed using the Unified MSA Rating Scale (UMSARS) and Clinical Global Impression of Improvement (CGI-I).

Results: 28 patients with early MSA of the parkinsonian subtype (MRI-positive n=13; MRI-negative n=15) were included in this analysis. Patients in the MRI-positive group had faster clinical progression from baseline to the end of the 48-week study compared with those in the MR-negative group as assessed by the UMSARS total (p=0.028) and UMSARS motor (p=0.008) scales. At week 48, MRI-positive patients also had a significantly worse health status vs. MRI-negative patients as measured by CGI-I (p=0.015).

Conclusions: This is the first study to demonstrate that MSA-specific abnormalities on structural MRI might represent an endophenotype of MSA-P that is associated with more rapid progression and an overall worse prognosis.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/presence-of-abnormalities-on-structural-mri-associate-with-faster-disease-progression-in-multiple-system-atrophy/