Evolution of retinal degeneration and prediction of disease activity in relapsing and progressive multiple sclerosis

Retinal optical coherence tomography has been identified as biomarker for disease progression in relapsing-remitting multiple sclerosis (RRMS), while the dynamics of retinal atrophy in progressive MS are less clear. We investigated retinal layer thickness changes in RRMS, primary and secondary progressive MS (PPMS, SPMS), and their prognostic value for disease activity. Here, we analyzed 2651 OCT measurements of 195 RRMS, 87 SPMS, 125 PPMS patients, and 98 controls from five German MS centers after quality control. Peripapillary and macular retinal nerve fiber layer (pRNFL, mRNFL) thickness predicted future relapses in all MS and RRMS patients while mRNFL and ganglion cell-inner plexiform layer (GCIPL) thickness predicted future MRI activity in RRMS (mRNFL, GCIPL) and PPMS (GCIPL). mRNFL thickness predicted future disability progression in PPMS. However, thickness change rates were subject to considerable amounts of measurement variability. In conclusion, retinal degeneration, most pronounced of pRNFL and GCIPL, occurs in all subtypes. Using the current state of technology, longitudinal assessments of retinal thickness may not be suitable on a single patient level.


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According to the Nature guidelines, we have used the term sex to describe the biological attribute.We considered both sexes.Sex was assigned according to hospital recordings.241 of 407 MS patients were female.It is described in the source data where the information of sex has been collected.Consent has been obtained for sharing of individual-level data of all participants.All analyses were corrected for participants' sex.
Datasets of patients with RRMS (N=261), SPMS (N=139), and PPMS (N=190) who were diagnosed according to the revised McDonald criteria 2017 were obtained from five MS centers (Düsseldorf, Münster, Berlin, Hamburg, and Munich).47.7% of patients were female.The median age and disease duration of all patients at baseline were 45 and 5 years respectively.
Patients had been recruited in the context of different non-interventional longitudinal OCT studies at five MS centers (Düsseldorf, Münster, Berlin, Hamburg, and Munich) from 13.10.2009 to 18.05.2020.
This was a retrospective study involving all available datasets from the participating centers.Due to the retrospective nature of the study, no power analysis was performed and due to the exploratory nature sensitivits analyses were not performed.
Exclusion criteria were any diseases of the optic nerve or retina not related to MS; a diagnosis of other neuroinflammatory disorders (i.e., neuromyelitis optica spectrum disorders); severe refraction anomalies !± 6 diopters; systemic conditions that could affect the visual system; treatment with substances with increased risk of iatrogenic retinopathy such as chemotherapy; insufficient scan quality according to the OSCAR-IB criteria.In MS patients, initial swelling and retinal atrophy in the context of acute ON has a major impact on retinal layer thickness.
For this reason, we excluded eyes with previous ON within 6 months to baseline OCT and those with ON between OCT measurements.Exclusion criteria were predefined.
Reproduction in an independent cohort will be of interest but was beyond the scope of this study.Nevertheless some of our results have been found in other studies and can thus be considered as reproduced.
non applicable, retrospective study Investigators were blinded for group allocation

Julia
Krämer and Philipp Albrecht Mar 29, 2024 No No software was used SPSS Statistics 26.0 (IBM) or or the lme4 package in in R Studio (version 1.3.1093)and Microsoft Excel 2021.All statistical codes for presented results are available under: https://github.com/AlexHartmann00/oct-ms.