From the Department of Neurology (G.B., N.K., K.R., P.A., B.K., F.L., S.M., P.P., P.S.R., G.Z., T.B.), Medical University of Vienna; and Department of Ophthalmology (C.M., B.P.), Medical University of Vienna, Austria.
Neurology. 2022 Oct 18;99(16):e1803-e1812. doi: 10.1212/WNL.0000000000200970. Epub 2022 Aug 2.
Remission of relapses is an important contributor to both short- and long-term prognosis in relapsing multiple sclerosis (RMS). In MS-associated acute optic neuritis (MS-ON), retinal layer thinning measured by optical coherence tomography (OCT) is a reliable biomarker of both functional recovery and the degree of neuroaxonal damage. However, prediction of non-ON relapse remission is challenging. We aimed to investigate whether retinal thinning after ON is associated with relapse remission after subsequent non-ON relapses.
For this longitudinal observational study from the Vienna MS database, we included patients with MS with (1) an episode of acute ON, (2) available spectral domain OCT scans within 12 months before ON onset (OCT), within 1 week after ON onset (OCT), and 3-6 months after ON (OCT), and (3) at least 1 non-ON relapse after the ON episode. Subsequent non-ON relapses were classified as displaying either complete or incomplete remission based on change in the Expanded Disability Status Scale score assessed 6 months after relapse. Association of retinal thinning in the peripapillary retinal nerve fiber layer (ΔpRNFL) and macular ganglion cell and inner plexiform layer (ΔGCIPL) with incomplete remission was tested by multivariate logistic regression models adjusting for age, sex, disease duration, relapse severity, time to steroid treatment, and disease-modifying treatment status.
We analyzed 167 patients with MS (mean age 36.5 years [SD 12.3], 71.3% women, mean disease duration 3.1 years [SD 4.5]) during a mean observation period of 3.4 years (SD 2.8) after the ON episode. In 61 patients (36.5%), at least 1 relapse showed incomplete remission. In the multivariable analyses, incomplete remission of non-ON relapse was associated with ΔGCIPL thinning both from OCT to OCT and from OCT to OCT (OR 2.4 per 5 μm, < 0.001, respectively), independently explaining 29% and 27% of variance, respectively. ΔpRNFL was also associated with incomplete relapse remission when measured from OCT to OCT (OR 1.9 per 10 μm, < 0.001), independently accounting for 22% of variance, but not when measured from OCT to OCT DISCUSSION: Retinal layer thinning after optic neuritis may be useful as a marker of future relapse remission in RMS.
缓解复发是影响复发型多发性硬化症（RMS）短期和长期预后的重要因素。在多发性硬化相关性急性视神经炎（MS-ON）中，光学相干断层扫描（OCT）测量的视网膜层变薄是功能恢复和神经轴突损伤程度的可靠生物标志物。然而，预测非 ON 复发缓解是具有挑战性的。我们旨在研究 ON 后视网膜变薄是否与随后非 ON 复发缓解相关。
本项来自维也纳 MS 数据库的纵向观察性研究纳入了具有以下特征的 MS 患者：（1）急性 ON 发作；（2）ON 发作前 12 个月内（OCT）、ON 发作后 1 周内（OCT）和 ON 发作后 3-6 个月内（OCT）有可用的谱域 OCT 扫描；（3）在 ON 发作后至少有 1 次非 ON 复发。根据复发后 6 个月时扩展残疾状况量表评分的变化，将随后的非 ON 复发分为完全缓解或不完全缓解。通过多变量逻辑回归模型，在校正年龄、性别、疾病持续时间、复发严重程度、类固醇治疗时间和疾病修正治疗状态后，检验视盘周围神经纤维层（ΔpRNFL）和黄斑神经节细胞和内丛状层（ΔGCIPL）的视网膜变薄与不完全缓解的相关性。
在 ON 发作后的平均 3.4 年（SD 2.8）的观察期间，我们分析了 167 例 MS 患者（平均年龄 36.5 岁[SD 12.3]，71.3%为女性，平均疾病持续时间 3.1 年[SD 4.5]）。在 61 例患者（36.5%）中，至少有 1 次复发表现为不完全缓解。在多变量分析中，非 ON 复发的不完全缓解与从 OCT 到 OCT 和从 OCT 到 OCT 的 ΔGCIPL 变薄相关（分别为每 5μm 增加 2.4，<0.001），分别独立解释了 29%和 27%的变异性。当从 OCT 到 OCT 测量时，ΔpRNFL 也与不完全缓解复发相关（每 10μm 增加 1.9，<0.001），独立解释了 22%的变异性，但从 OCT 到 OCT 测量时则不然。
视神经炎后视网膜层变薄可能是 RMS 未来复发缓解的有用标志物。
