{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T20:28:35Z","timestamp":1792787315264,"version":"4.5.0"},"reference-count":40,"publisher":"BMJ","funder":[{"name":"The AMED Brain\/MINDS Beyond Program","award":["JP18dm0307002"],"award-info":[{"award-number":["JP18dm0307002"]}]},{"name":"JSPS KAKENHI","award":["19K03309"],"award-info":[{"award-number":["19K03309"]}]},{"name":"JSPS KAKENHI","award":["21K03084"],"award-info":[{"award-number":["21K03084"]}]},{"name":"JSPS KAKENHI","award":["23K22361"],"award-info":[{"award-number":["23K22361"]}]},{"name":"JSPS KAKENHI","award":["24K21493"],"award-info":[{"award-number":["24K21493"]}]},{"name":"JSPS KAKENHI","award":["25H01085"],"award-info":[{"award-number":["25H01085"]}]},{"name":"JSPS KAKENHI","award":["25K00879"],"award-info":[{"award-number":["25K00879"]}]},{"name":"JSPS KAKENHI","award":["25K06842"],"award-info":[{"award-number":["25K06842"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["J Neurol Neurosurg Psychiatry"],"accepted":{"date-parts":[[2026,3,18]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Differences in brain atrophy rates between patients with aquaporin-4 IgG-positive neuromyelitis optica spectrum disorder (AQP4Ab+NMOSD) and healthy controls (HCs), as well as the impact of biologic agents (BIO) on brain atrophy, have not been fully examined.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In total, 72 patients with AQP4Ab+NMOSD identified at Chiba University Hospital or in the Berlin Registry of Neuroimmunological Entities (Chiba, 63; Berlin, 9) and 52 age-matched and sex-matched HCs (Chiba, 47; Berlin, 5) were included. Only patients without relapses between the baseline and follow-up MRI scans were included. Regional brain volumes were normalised to the intracranial volume. Patients who continuously used BIOs or non-BIO preventive treatments between the two MRI scans were assigned to the BIO or non-BIO subgroups, respectively. We applied a longitudinal combined association test to correct for MRI scanner differences.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Patient age and the interval between MRI scans did not differ between the groups. The NMOSD group exhibited a lower whole-brain volume than the HC group at follow-up (p&lt;0.001) and a significantly higher whole-brain atrophy rate (p=0.009). Patients with smaller subcortical grey matter (SGM) volumes at follow-up MRI exhibited greater clinical disability (\u03c1 = \u22120.27, p=0.022). In the BIO subgroup, early initiation of treatment (p=0.013) and a higher relative duration of BIO exposure (p=0.028) were associated with lower annualised SGM atrophy rates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This study suggested progressive silent brain atrophy in patients with AQP4Ab+NMOSD\u2009and that early BIO initiation might prevent the progression of brain atrophy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/jnnp-2025-338166","type":"journal-article","created":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T17:20:37Z","timestamp":1776273637000},"page":"jnnp-2025-338166","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Biologic therapy and brain atrophy in neuromyelitis optica: a Japanese\u2013German longitudinal MRI study"],"prefix":"10.1136","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4106-6482","authenticated-orcid":false,"given":"Hiroki","family":"Masuda","sequence":"first","affiliation":[{"name":"Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lina","family":"Anderhalten","sequence":"additional","affiliation":[{"name":"Experimental and Clinical Research Center (ECRC), A Cooperation Between Max Delbr\u00fcck Center for Molecular Medicine in the Helmholtz Association and Charit\u00e9 - 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