NAGM and NAWM can be affected early in the clinical course of MS. MRI measures such as magnetization transfer ratio (MTR) and diffusion tensor imaging (DTI) can help quantify this damage. FTY, NAT and GA are FDA approved disease-modifying therapies (DMT) for MS.

We retrospectively analyzed 85 3T MRI scans and identified changes in NAGM and NAWM among patients on FTY, GA, and NAT. Each patient underwent brain MRI scan on a SIEMENS 3T Verio scanner at baseline and year 1. MTR and DTI metrics were measured in NAGM and NAWM on each scan after lesion segmentation, lesion filling, brain tissue segmentation, and image masking. We compared the effect of three different DMT on NAGM and NAWM using the Mann-Whitney test in SPSS v26.

Comparison between NAT, FTY and GA showed significant differences in MTR-NAGM(p=.011),MD-NAGM(p=.006),MD-NAWM(p=.000),AD-NAGM(p=0.25), AD- NAWM(p=.000), RD-NAGM(p=.001), RD-NAWM(p=.000) from baseline to year 1 in favor of MS patients treated with NAT in comparison to FTY and GA. No significant difference was found between FTY and GA from baseline to year 1.

Our finding suggests that NAT might be more effective in protecting NAGM and NAWM compared to GA and FTY over one year period. Large longitudinal studies can better clarify the role of DMT on NAGM and NAWM in MS.