Highlights
- •Teriflunomide treated MS patients experienced decrease in anti-EBV IgG titers.
- •Decrease in anti-EBV was associated with less cortical and GM volume loss.
- •This study suggests a potential anti-viral effect of teriflunomide.
- •Teriflunomide's effect on cortical GM atrophy is related to anti-viral effect of teriflunomide.
Abstract
Background
Teriflunomide has been shown to slow cortical gray matter (GM) atrophy in patients
with multiple sclerosis (MS). Previous work showed that higher levels of Epstein-Barr
virus (EBV) are associated with greater development of cortical pathology in MS.
Objectives
To investigate whether the effect of teriflunomide on cortical volume loss in relapsing
MS patients may be associated with the change in humoral response to EBV.
Methods
This was a prospective, observational, single-blinded, longitudinal study of 30 relapsing
MS patients, who started treatment with teriflunomide, and 20 age- and sex-matched
healthy controls (HCs). Subjects were assessed at baseline, 6 and 12 months with clinical,
MRI and EBV examinations. MRI outcomes included percent changes in cortical, GM, deep
GM and whole brain volumes. Serum samples were analyzed for IgG antibodies titers
against EBV viral capsid antigen (VCA) and nuclear antigen-1 (EBNA-1).
Results
There were no significant differences in anti-VCA and anti-EBNA-1 IgG titers between
MS patients and HC at baseline. However, over the 12-month follow-up, MS patients
experienced a greater decrease in anti-EBNA-1 (−35.1, p = .003) and anti-VCA (−15.9, p = .05) IgG titers, whereas no significant changes were observed in HCs (−3.7 and
−1.6, respectively). MS patients who showed the highest decrease in anti-EBV VCA and
EBNA-1 IgG titers from baseline to follow-up, developed less cortical (p < .001 and p = .02) and GM volume loss (p = .004 for both), respectively.
Conclusions
Teriflunomide's effect on slowing cortical and GM volume loss may be mediated by its
effect on altering humoral response to EBV.
Keywords
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Article info
Publication history
Published online: September 09, 2019
Accepted:
September 7,
2019
Received in revised form:
August 16,
2019
Received:
June 26,
2019
Identification
Copyright
© 2019 Elsevier B.V. All rights reserved.
