b'Medicine & ResearchRX UpdateEmerging DMTs for NeurodegenerationBy Ellen Whipple, Pharm.D.Multiple sclerosis has traditionally been to be benecial. As MS progresses, the balanceconsidered a disease aecting the white matter between degenerative and reparative processesof the brain. More recent data has suggested shifts, resulting in progressive neuroaxonallesions and demyelination also occur in the degeneration and increasing disability.gray matter structures of the brain. According Because brain atrophy creates permanentto Dr. Ben Thrower, medical director of the MS damageandcorrelateswithphysicalandInstitute at the Shepherd Center in Atlanta, cognitive disability, it is important that patientsA growing body of evidence suggests that with MS be treated as early in the diseasegray matter involvement is at least partially process as possible with DMTs. Additionally,independent from white matter involvement.patients having CIS and RIS who are at high-riskAlthough both gray and white matter for developing clinically-denite MS shouldundergo atrophy, data suggests the loss of also receive treatment with DMTs as soon asgray matter may be a more sensitive marker possible.of the neurodegeneration and cognitive Several clinical trials have provided proof-of-impairment. Dr. Thrower explained that atrophy concept for an early window of rst treatmentassociated with gray matter structures correlates intervention in patients with CIS. Signicantwith certain clinical symptoms, such as: reductions (39-50 percent) in the risk of Cerebellar gray matter atrophy with developing clinically denite MS were observedcerebellar symptoms and hand function, with the interferon beta products and glatiramer Upper cervical cord atrophy with acetate when early treatment was initiated.ambulatory dysfunction, Physical disability and number and volume Hippocampal atrophy with ambulatory of brain lesions was also improved with earlydecits, and treatment. The gure below further describes Thalamic volume with cognitiveimpairment.Importance of early diagnosisand treatment MS is characterized by both inammationand progressive neuroaxonal damage. Thisdamage occurs even in the early stages of MS;however, it may be masked by compensatorymechanisms. The progressive damage may gounrecognized until it is too late for intervention FIGURE: Brain atrophy occurs early in the disease process.msfocusmagazine.org 56'