Do all DMTs have the same protective effect on brain volume?

According to new research published in the journal PLoS One, some disease-modifying therapies (DMTs) that are currently recommended to people with multiple sclerosis (MS) as their first treatment may not be the most effective therapies for preventing brain volume loss.

It is essential that people with MS retain as healthy a brain as possible, and brain volume is known to be a measure of brain health. The protective effects of DMTs can be evaluated by measuring changes in brain volume. Branger and colleagues analysed data collected in clinical trials to examine the rate of brain volume loss in people with relapsing–remitting MS (RRMS). They compared the changes in brain volume among two groups of people with RRMS: those receiving a DMT recommended by the European Medicines Agency as one of the first therapies to try (a so-called ‘first-line’ therapy), and those receiving a DMT that is only available after a first-line therapy has been tried without success (‘second-line’ therapy).

After analysing data from over 18 000 people in 35 clinical trials, the researchers found that brain volume decreased more over a 24-month period in people who had been receiving a first-line therapy than in those who had been receiving a second-line therapy. Furthermore, people receiving a second-line therapy retained brain volume better than those receiving a dummy treatment (known as placebo); there was no such difference between individuals receiving a first-line therapy and those receiving placebo.

It should be noted that participants in clinical trials are probably receiving a treatment for the first time, and therefore may respond differently from those who have tried more than one therapy. Nevertheless, these findings support the recommendations outlined in Brain health: time matters in multiple sclerosis, which state that the full range of DMTs should be made available to people with MS. The report emphasizes the importance of finding the most appropriate DMT for each individual, in a decision-making process that is shared between the person with MS and their team of healthcare professionals.


  1. Branger P, Parienti JJ, Sormani MP et al. The effect of disease-modifying drugs on brain atrophy in relapsing-remitting multiple sclerosis: a meta-analysis. PLoS One 2016:16;11:e0149685.

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