Permeability of the blood-brain barrier predicts no evidence of disease activity at two years after natalizumab or fingolimod treatment in relapsing-remitting multiple sclerosis

Dynamic contrast-enhanced MRI enables measurements of the permeability of the blood-brain barrier (BBB), possibly a marker of disease activity in multiple sclerosis (MS). In order to investigate if permeability predicts early suboptimal treatment response, defined as loss of no evidence of disease activity (NEDA) status after two years, we included 35 relapsing-remitting MS patients initiating either fingolimod or natalizumab, drugs with a common effect of decreasing lymphocyte influx into the CNS. We find that permeability measured after six months of treatment was a good predictor loss of NEDA status at two years and a surrogate marker of the state of health of the blood-brain barrier.