Department of Neurology, Medical University of Vienna, Vienna, Austria; Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria.
Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.
Mult Scler. 2024 Aug;30(9):1128-1138. doi: 10.1177/13524585241267257. Epub 2024 Aug 7.
Employing a rebaselining concept may reduce noise in retinal layer thinning measured by optical coherence tomography (OCT).
From an ongoing prospective observational study, we included patients with relapsing multiple sclerosis (RMS), who had OCT scans at disease-modifying treatment (DMT) start (baseline), 6-12 months after baseline (rebaseline), and ⩾12 months after rebaseline. Mean annualized percent loss (aL) rates (%/year) were calculated both from baseline and rebaseline for peripapillary-retinal-nerve-fiber-layer (aLpRNFL/aLpRNFL) and macular-ganglion-cell-plus-inner-plexiform-layer (aLGCIPL/aLGCIPL) by mixed-effects linear regression models.
We included 173 RMS patients (mean age 31.7 years (SD 8.8), 72.8% female, median disease duration 15 months (12-94) median baseline-to-last-follow-up-interval 37 months (18-71); 56.6% moderately effective DMT (M-DMT), 43.4% highly effective DMT (HE-DMT)). Both mean aLpRNFL and aLGCIPL significantly increased in association with relapse (0.51% and 0.26% per relapse, < 0.001, respectively) and disability worsening (1.10% and 0.48%, < 0.001, respectively) before baseline, but not with DMT class. Contrarily, neither aLpRNFL nor aLGCIPL was dependent on relapse or disability worsening before baseline, while HE-DMT significantly lowered aLpRNFL (by 0.31%, < 0.001) and aLGCIPL (0.25%, < 0.001) compared with M-DMT.
Applying a rebaselining concept significantly improves differentiation of DMT effects on retinal layer thinning by avoiding carry-over confounding from previous disease activity.
采用重新基线化概念可以减少光学相干断层扫描（OCT）测量的视网膜层变薄中的噪声。
我们纳入了正在进行的前瞻性观察性研究中的复发型多发性硬化症（RMS）患者，这些患者在疾病修正治疗（DMT）开始时（基线）、基线后 6-12 个月（重新基线）和重新基线后 ⩾12 个月时进行 OCT 扫描。通过混合效应线性回归模型，从基线和重新基线计算了视盘周围视网膜神经纤维层（aLpRNFL/aLpRNFL）和黄斑神经节细胞加内丛状层（aLGCIPL/aLGCIPL）的平均年化损失率（aL）（%/年）。
我们纳入了 173 名 RMS 患者（平均年龄 31.7 岁（8.8 岁），72.8%为女性，中位疾病持续时间为 15 个月（12-94），中位基线至最后随访间隔为 37 个月（18-71）；56.6%的患者接受了中度有效的 DMT（M-DMT），43.4%的患者接受了高效的 DMT（HE-DMT））。在基线之前，与复发（分别为 0.51%和 0.26%/复发，<0.001）和残疾恶化（分别为 1.10%和 0.48%，<0.001）相关，aLpRNFL 和 aLGCIPL 的平均值均显著增加，但与 DMT 类别无关。相反，在基线之前，aLpRNFL 和 aLGCIPL 均不受复发或残疾恶化的影响，而与 M-DMT 相比，HE-DMT 显著降低了 aLpRNFL（0.31%，<0.001）和 aLGCIPL（0.25%，<0.001）。
通过避免以前疾病活动的残留混杂，应用重新基线化概念可显著改善 DMT 对视网膜层变薄的影响的区分。
