by Raphael Wurm
Each month the eanNews editorial team reviews the scientific press for recently published papers of outstanding interest to neurologists. Below we present our selection for May 2025.
High-Dose Vitamin D Reduces Disease Activity in Early MS | JAMA Neurology
The D-Lay MS trial, a multicentre, double-blind randomised clinical study, assessed the effect of high-dose vitamin D on disease activity in patients with clinically isolated syndrome (CIS) typical for multiple sclerosis (MS). A total of 316 participants were randomised 1:1 to receive 100,000 IU oral cholecalciferol or placebo every two weeks for 24 months. The primary analysis included 303 patients (163 vitamin D, 153 placebo), with a median age of 34 years (IQR 28–42), of whom 70% were women.
Disease activity—defined as either clinical relapse or new/contrast-enhancing lesions on MRI—was significantly lower in the vitamin D group (94/156, 60.3%) compared to placebo (109/147, 74.1%) with an HR of 0.66 (95% CI, 0.50–0.87; P = .004). Median time to disease activity was longer with vitamin D (432 days vs 224 days; log-rank P = .003). Secondary MRI outcomes also favoured vitamin D: any MRI activity occurred in 57.1% vs 65.3% (P = .02), new lesions in 46.2% vs 59.2% (P = .003), and contrast-enhancing lesions in 18.6% vs 34.0% (P = .001). Safety profiles were similar, with no serious adverse events linked to vitamin D.
These results suggest that high-dose vitamin D significantly reduces radiological disease activity in CIS and early relapsing-remitting MS, warranting further exploration as an add-on therapeutic strategy.
Read the paper here: High-Dose Vitamin D in Clinically Isolated Syndrome Typical of Multiple Sclerosis: The D-Lay MS Randomized Clinical Trial | Demyelinating Disorders | JAMA | JAMA Network
Quantitative MRI Detects Occipital Cortical Inflammation in Migraine With Aura | Annals of Neurology
This large cross-sectional study applied a novel, multimodal MRI protocol to investigate cortical inflammation in migraine, focusing on differences between migraine with and without aura. A total of 296 adults with migraine (103 with aura, 180 with chronic migraine, 88 scanned during an attack) and 155 age- and sex-matched healthy controls underwent imaging using T2, T1, and ADC mapping to assess tissue water content, microstructural integrity, and oedema.
The primary finding was significantly elevated quantitative T2 (qT2) values, which are believed to represent extracellular oedema or accumulation of inflammatory microglia or astrocytesuch, in the left occipital cortex of migraine patients compared to controls mean difference, 1.29 ms; p < 0.0001). In those with migraine with aura, qT2 was increased bilaterally: left occipital cortex (mean difference, 1.52 ms; p < 0.0001) and right occipital cortex (mean difference, 0.91 ms; p = 0.004).
Since the findings were less pronounced in migraine without aura, cortical inflammation may be more prominent in the aura subtype. The results provide in vivo evidence supporting a neuroinflammatory component in migraine pathophysiology, particularly involving the occipital cortex in patients with aura.
GLP-1 and SGLT2 Inhibitors Linked to Lower Dementia Risk in Type 2 Diabetes | JAMA Neurology
In this large emulated trial, the authors recruited more than 90,000 patients using electronic health record data from the OneFlorida+ Clinical Research Consortium to compare the risk of Alzheimer’s disease (AD) among individuals aged ≥50 with type 2 diabetes. They identified individuals who initiated treatment with a GLP-1 receptor agonist (GLP-1RA), an SGLT2 inhibitor (SGLT2i) and compared them to those starting another second-line glucose-lowering drug (GLD). The outcome was a diagnosis of AD using diagnostic coding algorithms.
GLP-1RA initiators (n=33,858) had an AD incidence rate of 2.26 per 1000 person-years lower than those on other second-line GLDs, with a hazard ratio (HR) of 0.67 (95% CI, 0.47–0.96). Similarly, SGLT2i users (n=34,185) showed an even larger reduction in AD incidence (−3.05 per 1000 person-years), corresponding to an HR of 0.57 (95% CI, 0.43–0.75). In direct comparison, GLP-1RAs and SGLT2is did not differ significantly (HR 0.97, 95% CI, 0.72–1.32; rate difference −0.09 per 1000 person-years, 95% CI −0.80 to 0.63).
These findings support a potential neuroprotective effect of both GLP-1RAs and SGLT2is in T2D, increasing the anticipation around ongoing trials of these drugs in early AD and potentially opening the door to prevention studies.
Read the paper here: GLP-1RA and SGLT2i Medications for Type 2 Diabetes and Alzheimer Disease and Related Dementias | Diabetes | JAMA Neurology | JAMA Network
