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OCT may help predict disease activity in CIS



Baseline measurements of the eye may help neurologists predict future disease activity and diagnosis after the first attack of clinically isolated syndrome (CIS), according to research presented at the meeting held by the Americas Committee for Treatment and Research in Multiple Sclerosis. The results suggest that optical coherence tomography (OCT) could support patient monitoring and the initiation of disease-modifying therapy.

“Treatment of early MS [multiple sclerosis] is crucial to prevent neuroaxonal damage and, thus, sustained disability,” said Hanna G. Zimmermann, PhD, a research associate at NeuroCure Clinical Research Center at Charité Universitätsmedizin in Berlin. The ability to identify patients at high risk of future disease activity shortly after disease onset could help optimize patient management and guide the initiation of disease-modifying therapy. Dr. Zimmermann and colleagues investigated whether retinal OCT could predict disease activity in patients with CIS.

The investigators included 97 patients (mean age, 33.6 years; 62.9% female) with CIS in a prospective, longitudinal cohort study. Diagnoses of CIS were based on the 2010 revisions to the McDonald criteria. Patients were enrolled from two German centers within 12 months after a first clinical event. The researchers performed a neurologic examination, cerebral MRI, and retinal OCT for each participant and followed the population for 729 days (median, 664 days).

The primary OCT predictor was ganglion cell and inner plexiform (GCIP) layer thickness, because this parameter is stable and reliable for quantifying neuronal visual system damage in MS, said Dr. Zimmermann. Secondary OCT predictors were peripapillary retinal nerve fiber layer (pRNFL) thickness and inner nuclear layer (INL) thickness. The investigators only included eyes without a history of optic neuritis in the analysis.

The study’s primary outcome was failing the no evidence of disease activity (NEDA-3) criteria (no relapses, no disability progression, and no MRI activity). The secondary outcomes were MS diagnosis (according to the 2010 McDonald criteria) and worsening of disability.

At baseline, Dr. Zimmerman and colleagues found no differences in thickness of GCIP and pRNFL between patients and matched healthy controls. In all, 58 patients (59%) failed NEDA-3 criteria during follow-up. When Dr. Zimmermann and colleagues conducted Kaplan-Meier analysis, they found that patients with thinner GCIP thickness had a significantly higher risk of failing NEDA-3 criteria (thinnest vs. thickest tertile: hazard ratio, 3.33). A follow-up diagnosis of MS also was significantly more likely among patients with low GCIP thickness (thinnest vs. thickest tertile: HR, 4.05).

In addition, low pRNFL thickness indicated an increased risk of not meeting NEDA-3 criteria (thinnest vs. thickest tertile: HR, 2.46). However, neither INL thickness nor T2-weighted lesion count were associated with failing NEDA-3 criteria. Also, none of the OCT parameters were associated with future disability worsening.

Among the study’s limitations are its small sample size, the relatively short observation time, and the heterogeneity of patients between the two centers, which used different study protocols, said Dr. Zimmermann.

“OCT-assessed GCIP is promising for the early appraisal of future disease activity and might thus be helpful for risk-adjusted patient participation in clinical research,” she said. “It might also be helpful for clinicians for identifying CIS patients with worse prognosis and planning the care.” Dr. Zimmermann and colleagues plan to use advanced imaging techniques in future studies to understand the mechanisms behind the associations they identified. They hope to confirm their findings in a larger cohort and examine whether OCT can predict clinical outcomes such as relapses, disability worsening, and the extent of disease activity.

Dr. Zimmermann had no relevant disclosures and did not report a source of funding for the study.

SOURCE: Zimmermann HG et al. ACTRIMS Forum 2020, Abstract.

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