Evolution from a first clinical demyelinating event to multiple sclerosis in the REFLEX trial: Regional susceptibility in the conversion to multiple sclerosis at disease onset and its amenability to subcutaneous interferon beta-1a

Marco Battaglini, Hugo Vrenken, Riccardo Tappa Brocci, Giordano Gentile, Ludovico Luchetti, Adriaan Versteeg, Mark S. Freedman, Bernard M. J. Uitdehaag, Ludwig Kappos, Giancarlo Comi, Andrea Seitzinger, Dominic Jack, Maria Pia Sormani, Frederik Barkhof, Nicola de Stefano

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Background and purpose: In the REFLEX trial (ClinicalTrials.gov identifier: NCT00404352), patients with a first clinical demyelinating event (FCDE) displayed significantly delayed onset of multiple sclerosis (MS; McDonald criteria) when treated with subcutaneous interferon beta-1a (sc IFN β-1a) versus placebo. This post hoc analysis evaluated the effect of sc IFN β-1a on spatio-temporal evolution of disease activity, assessed by changes in T2 lesion distribution, in specific brain regions of such patients and its relationship with conversion to MS. Methods: Post hoc analysis of baseline and 24-month magnetic resonance imaging data from FCDE patients who received sc IFN β-1a 44 μg once or three times weekly, or placebo in the REFLEX trial. Patients were grouped according to McDonald MS status (converter/non-converter) or treatment (sc IFN β-1a/placebo). For each patient group, a baseline lesion probability map (LPM) and longitudinal new/enlarging and shrinking/disappearing LPMs were created. Lesion location/frequency of lesion occurrence were assessed in the white matter. Results: At Month 24, lesion frequency was significantly higher in the anterior thalamic radiation (ATR) and corticospinal tract (CST) of converters versus non-converters (p < 0.05). Additionally, the overall distribution of new/enlarging lesions across the brain at Month 24 was similar in placebo- and sc IFN β-1a-treated patients (ratio: 0.95). Patients treated with sc IFN β-1a versus placebo showed significantly lower new lesion frequency in specific brain regions (cluster corrected): ATR (p = 0.025), superior longitudinal fasciculus (p = 0.042), CST (p = 0.048), and inferior longitudinal fasciculus (p = 0.048). Conclusions: T2 lesion distribution in specific brain locations predict conversion to McDonald MS and show significantly reduced new lesion occurrence after treatment with sc IFN β-1a in an FCDE population.

Original languageEnglish
Pages (from-to)2024-2035
Number of pages12
JournalEuropean journal of neurology
Issue number7
Early online date2022
Publication statusPublished - Jul 2022


  • first clinical demyelinating event
  • interferon-beta
  • lesions
  • white matter tracts

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