Zimmermann HG, et al. - Given that patient monitoring and the initiation of disease-modifying therapy in patients with clinically isolated syndrome (CIS) essentially requires detection of those with a high risk of future disease activity and subsequent multiple sclerosis (MS) diagnosis, researchers investigated whether there exists a link between optical coherence tomography (OCT) results and future disease activity in patients with CIS. According to findings, in patients with CIS, the imaging marker that might prove to be valuable for anticipating future disease activity and diagnosis of MS is retinal ganglion cell and inner plexiform layer thickness, which can potentially support patient monitoring and initiation of disease-modifying therapy.

Methods

• This was a prospective, longitudinal cohort study.
• This study was conducted between January 2011 and May 2017 at 2 German tertiary referral centers.
• A total of 179 patients with CIS were screened (80 in Berlin and 99 in Munich) for this study, patients had neurological examination, magnetic resonance imaging (MRI), and OCT done.
• For OCT analysis, only eyes with no previous optic neuritis were considered.
• Not meeting the no evidence of disease activity (NEDA-3) criteria was primary outcome; MS diagnosis (by the 2010 McDonald criteria) and worsening of disability were assessed as secondary outcomes.
• OCT-derived ganglion cell and inner plexiform layer thickness was primary measure; the secondary measures included peripapillary retinal nerve fiber layer thickness, inner nuclear layer thickness, and MRI-derived T2-weighted lesions.

Results

• A total of 179 patients were screened.
• Of these, 97 (54.2%) were enrolled in the study at a median of 93 (interquartile range [IQR], 62-161) days after a first demyelinating event.
• Follow-up was performed for a median duration (Kaplan-Meier survival time) of 729 (IQR, 664-903) days.
• During the follow-up period, 58 (59%) of 97 patients with CIS (mean age 33.6 [7.9] years; 61 [62.9%] female) did not meet NEDA-3 criteria.
• By Kaplan-Meier analysis, there was a significant probability difference in not meeting NEDA-3 criteria by ganglion cell and inner plexiform later thickness (thinnest vs thickest tertile: hazard ratio [HR], 3.33 [95% CI, 1.70-6.55; P<.001; log-rank P=.001).
• Findings suggested a greater likeliness for a follow-up diagnosis of MS among patients with low ganglion cell and inner plexiform layer thickness (thinnest vs thickest tertile: HR, 4.05 [95% CI, 1.93-8.50]; P<.001).
• Risk of not meeting NEDA-3 criteria was likewise indicated by low peripapillary retinal nerve fiber layer thickness (thinnest vs thickest tertile: HR, 2.46 [95% CI, 1.29-4.66]; P=.01; log-rank P=.02).
• Inner nuclear layer thickness and T2-weighted lesion count were not found to be related to not meeting NEDA-3 criteria.