Evidence map›Paper›PMID 38980342›Full record

Trial reportJournal of neurology2024

Dimethyl fumarate preserves brainstem and cervical spinal cord integrity in radiologically isolated syndrome.

Darin T Okuda, Christina J Azevedo, Daniel Pelletier, Tatum M Moog, Saeed Moazami, Sepideh Rezvani, Francesca Bovis, Maria Pia Sormani, Aksel Siva, Orhun Kantarci and 2 more

Abstract readRandomized Controlled Trial
PubMed Publisher
In one paragraph

Trial report in Journal of neurology, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Article
  2. Upper cervical spinal cord atrophy in MS: Sex, menopause, and neurodegeneration.Multiple sclerosis (Houndmills, Basingstoke, England) · 2025
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

12 authors.

Darin T Okuda *Department of Neurology, Neuroinnovation Program, Multiple Sclerosis & Neuroimmunology Imaging Program, The University of Texas Southwestern Medical Center, 5303 Harry Hines Blvd., Dallas, TX, 75390-8806, USA. darin.okuda@UTsouthwestern.edu.ORCID http://orcid.org/0000-0002-6499-1523
Christina J Azevedo *University of Southern California, Los Angeles, CA, USA.
Daniel PelletierUniversity of Southern California, Los Angeles, CA, USA.
Tatum M MoogDepartment of Neurology, Neuroinnovation Program, Multiple Sclerosis & Neuroimmunology Imaging Program, The University of Texas Southwestern Medical Center, 5303 Harry Hines Blvd., Dallas, TX, 75390-8806, USA.
Saeed MoazamiUniversity of Southern California, Los Angeles, CA, USA.
Sepideh RezvaniUniversity of Southern California, Los Angeles, CA, USA.
Francesca BovisUniversity of Genoa, Genoa, Italy.
Maria Pia SormaniUniversity of Genoa, Genoa, Italy.
Aksel SivaUniversity of Cerrahpasa School of Medicine, Istanbul, Turkey.
Orhun KantarciMayo Clinic, Rochester, MN, USA.
Christine Lebrun-FrénayUniversitaire de Nice, Nice, France.
ARISE Study Investigators

Funding

Biogen 109MS001
6 · The paper itself

Abstract

background and purposeThe first randomized placebo-controlled therapeutic trial in radiologically isolated syndrome (RIS), ARISE, demonstrated that treatment with dimethyl fumarate (DMF) delayed the onset of a first clinical event related to CNS demyelination and was associated with a significant reduction in new and/or newly enlarging T2-weighted hyperintense lesions. The purpose of this study was to explore the effect of DMF on volumetric measures, including whole brain, thalamic, and subcortical gray matter volumes, brainstem and upper cervical spine three-dimensional (3D) volumes, and brainstem and upper cervical spine surface characteristics.

methodsStandardized 3T MRIs including 3D isotropic T1-weighted gradient echo images were acquired at baseline and end-of-study according to the ARISE study protocol. The acquired data were analyzed using Structural Image Evaluation Using Normalization of Atrophy (SIENA), FreeSurfer v7.3, and an in-house pipeline for 3D conformational metrics. Multivariate mixed models for repeated measures were used to analyze rates of change in whole brain, thalamic, subcortical gray matter, as well as change in the 3D surface curvature of the dorsal pons and dorsal medulla and 3D volume change at the medulla-upper cervical spinal cord.

resultsThe study population consisted of 64 RIS subjects (DMF:30, placebo:34). No significant difference was seen in whole brain, thalamic, or subcortical gray matter volumes in treated vs. untreated RIS patients. A significant difference was observed in dorsal pons curvature with the DMF group having a lower least squares mean change of - 4.46 (standard estimate (SE): 3.77) when compared to placebo [6.94 (3.71)] (p = 0.036). In individuals that experienced a first clinical event, a greater reduction in medulla-upper cervical spinal cord volume (p = 0.044) and a decrease in surface curvature was observed at the dorsal medulla (p = 0.009) but not at the dorsal pons (p = 0.443).

conclusionsThe benefit of disease-modifying therapy in RIS may extend to CNS structures impacted by neurodegeneration that is below the resolution of conventional volumetric measures.

Indexed as

Brain StemCervical CordDimethyl FumarateMagnetic Resonance ImagingAdultDemyelinating DiseasesDouble-Blind MethodFemaleHumansImmunosuppressive AgentsMaleMiddle AgedYoung AdultDimethyl FumarateImmunosuppressive Agents3DAtrophyDimethyl fumarateMRIRadiologically isolated syndromeVolumetrics

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.