Improvement in Cognitive Function as Measured by NeuroTrax in Patients with Relapsing Multiple Sclerosis Treated with Na
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ORIGINAL RESEARCH ARTICLE
Improvement in Cognitive Function as Measured by NeuroTrax in Patients with Relapsing Multiple Sclerosis Treated with Natalizumab: A 2‑Year Retrospective Analysis Mark Gudesblatt1 · Karl Wisseman1 · Myassar Zarif1 · Barbara Bumstead1 · Lori Fafard1 · Jeffrey Wilken2 · Karen Blitz1 · Marijean Buhse1 · Sourav Santra3 · Christophe Hotermans3 · Lily Lee3
© The Author(s) 2018
Abstract Background Cognitive impairment affects many patients with multiple sclerosis (MS). NeuroTrax, a computerized cognitive screen that can be administered during routine clinical care, provides a consistent, validated, objective cognitive profile measure with a global cognitive score (GCS) and seven individual domain scores. Natalizumab is an efficacious therapy for relapsing MS, demonstrating reductions in disability worsening and MS disease activity measured by magnetic resonance imaging. Objective The aim of this study was to assess cognitive function as measured by NeuroTrax in MS patients treated with natalizumab for ≥ 2 years. Methods This retrospective observational study included adult MS patients in the United States who received 300 mg intravenous natalizumab every 4 weeks for ≥ 2 years. NeuroTrax data were evaluated at baseline and yearly thereafter. Changes in GCS and the seven individual cognitive domain scores from baseline to after 24 infusions of natalizumab were analyzed. Results In the study population at baseline (N = 52), 22 patients (42.3%) had disease duration of 0–5 years; 12 patients (23.1%) were treatment naive. GCS score improved significantly from baseline [mean 95.5, standard deviation (SD) 12.9] to year 2 (mean 98.9, SD 13.2; change from baseline 3.4; p = 0.003). After 2 years on natalizumab, 17 patients (32.7%) demonstrated clinically significant improvement (increase from baseline > 1 SD) in GCS. Results were similar regardless of whether patients had previously received MS therapy. Conclusions Patients treated with natalizumab demonstrated significant improvement in cognitive function, measured by NeuroTrax GCS, over 2 years of treatment. Key Points Natalizumab significantly improved NeuroTrax global cognitive score over 2 years of treatment, regardless of whether patients were treatment-naive or were previously treated with other disease-modifying therapies. Numerical improvements were observed for all seven individual cognitive domains from baseline to 2 years. These results indicate that some aspects of cognitive impairment can be reduced in patients with multiple sclerosis treated with natalizumab. * Lily Lee [email protected] 1
South Shore Neurologic Associates, Patchogue, NY, USA
2
Washington Neuropsychology Research Group LLC, Fairfax, VA, USA
3
Biogen, 225 Binney Street, Cambridge, MA 02142, USA
1 Introduction Cognitive impairment affects approximately 40‒65% of patients with multiple sclerosis (MS) [1, 2], but may be insufficiently recognized or monitored [3]. Nonetheless, cognitive impairment has a significant adverse impact on the quality of life a
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