New acute and chronic black holes in patients with multiple sclerosis randomised to interferon beta-1b or glatiramer acetate

Background: Hypointense lesions on T1 weighted MRI, referred to as black holes (BH), are a marker of demyelination/axonal loss in multiple sclerosis (MS). There is some evidence that glatiramer acetate (GA) may decrease the conversion of new brain lesions to BH. Methods: Monthly 3-Tesla brain MRI scans were used for up to 2 years to study the development and evolution of new BH in 75 patients with MS randomised to GA or Interferon β-1b (IFNβ1b) in the BECOME study. Findings: Of 1224 newly enhancing lesions (NEL) appearing at baseline through 24 months in 61 patients, 767 (62.7%) showed an acute BH (ABH). The majority of ABH were transient and of similar duration by treatment group. Of 571 ABH in which MRI follow-up scans were available for ⩾1 year, 103 (18.8%) were still visible ⩾12 months after onset and were considered chronic BH (CBH). Only 12.1% of the 849 NEL with MRI follow-up ⩾1 year converted to CBH, 9.8% with IFNβ1b and 15.2% with GA (p = 0.02). The conversion from ABH to CBH was also lower with IFNβ1b (15.2%) than with GA (21.4%), of borderline significance (p = 0.06). The majority of patients who developed NEL did not develop CBH; however, about a quarter had conversion rates from ABH to CBH greater than 20%. Interpretation: Only a minority of new brain lesions in patients with MS treated with GA or IFNβ1b convert to CBH.