A comparison of natalizumab's effects on SDMT between pediatric-onset and adult-onset multiple sclerosis patients

Marco Puthenparampil; Graziana Scialpi; Marta Gaggiola; Giovanni Zanotelli; Alessandro Miscioscia; Angela Berardi; Alice Riccardi; Margherita Nosadini; Stefano Sartori; Paola Perini; Francesca Rinaldi; Paolo Gallo

doi:10.3389/fneur.2024.1475161

A comparison of natalizumab's effects on SDMT between pediatric-onset and adult-onset multiple sclerosis patients

Front Neurol. 2024 Nov 6:15:1475161. doi: 10.3389/fneur.2024.1475161. eCollection 2024.

Authors

Marco Puthenparampil^{1

2}, Graziana Scialpi¹, Marta Gaggiola^{1

2}, Giovanni Zanotelli^{1

2}, Alessandro Miscioscia^{1

3}, Angela Berardi¹, Alice Riccardi¹, Margherita Nosadini^{4

5}, Stefano Sartori^{4

5}, Paola Perini², Francesca Rinaldi², Paolo Gallo^{1

2}

Affiliations

¹ Department of Neurosciences, University of Padua, Padova, Italy.
² Multiple Sclerosis Centre, Azienda Ospedaliera di Padova, Padova, Italy.
³ Padua Neuroscience Centre, University of Padua, Padova, Italy.
⁴ Paediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University Hospital of Padova, Padova, Italy.
⁵ Neuroimmunology Group, Paediatric Research Institute "Città della Speranza", Padova, Italy.

Abstract

Background: Pediatric-onset multiple sclerosis (POMS) patients often exhibit a wide range of cognitive deficits. Therefore, therapeutic approaches should aim not only to prevent cognitive decline but also to promote cognitive improvement.

Objective: This study aimed to explore the effects of natalizumab (NTZ) on cognitive function, as measured by the Symbol Digit Modalities Test (SDMT), in both POMS and adult-onset multiple sclerosis (AOMS) patients.

Method: A total of 63 patients (34 AOMS and 29 POMS) were enrolled in this retrospective, single-center study. Patients were clinically and radiologically assessed every 6 months, and they completed the SDMT at baseline and after at least 24 months of follow-up. SDMT values were reported as corrected values (cSDMT) and z-scores (zSDMT). Annualized cSDMT and zSDMT scores were calculated by dividing the change in scores by the length of the follow-up period (expressed in years).

Results: Both POMS and AOMS groups showed improvement in annualized cSDMT and zSDMT scores, but the improvement was significantly greater in the POMS group compared to the AOMS group (+3.85 ± 4.32 vs. +1.76 ± 2.80, p = 0.010 for cSDMT; 0.41 ± 0.40 vs. 0.25 ± 0.34, p = 0.026 for zSDMT). After re-baselining at 6 months, 93% of POMS patients (27 patients) and 85.3% of AOMS patients (29 patients, p = 0.84) achieved NEDA-3 (no evidence of disease activity). The NEDA-3 status, along with clinical and demographic parameters at baseline, did not account for the observed SDMT improvement.

Conclusion: The favorable clinical, radiological, and neuropsychological outcomes observed in this study support the use of natalizumab as a viable treatment option in POMS.

Keywords: Symbol Digit Modalities Test; multiple sclerosis; natalizumab; neuropsychological outcome; pediatric-onset multiple sclerosis.

Grants and funding

The author(s) declare that financial support was received for the research, authorship, and/or publication of this article. The project was supported by Biogen Idec (Protect Study). The funder was not involved in the study design, collection, analysis, interpretation of data, the writing of this article, or the decision to submit it for publication. Open Access funding provided by Università degli Studi di Padova | University of Padua, Open Science Committee.