Retinal Layer Thickness May be Predictive of PIRA Risk in Those Newly Diagnosed with RMS

Study results presented at the 40th Congress of the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) demonstrated that retinal layer thickness assessed by optical coherence tomography (OCT) improved risk stratification for progression independent of relapse activity (PIRA) in individuals newly diagnosed with relapsing multiple sclerosis (RMS). PIRA is a main cause of disability progression in individuals with RMS. This study suggests that retinal thickness can serve as a biomarker for PIRA risk, which can help physicians select appropriate disease-modifying treatments (DMTs) for individuals with RMS. 

The prospective observational study took place over a median observation period of 70 months and included 313 RMS patients who received an OCT scan within 90 days of their initial RMS diagnosis. Of these participants, 31% received highly effective (HE)-DMTs and 60.7% received moderately effective DMTs. Researchers used multivariate Cox regression models adjusting for clinical and MRI covariates to investigate the association of peripapillary retinal nerve fiber layer (pRNFL) and macular ganglion-cell-and-inner-plexiform-layer (GCIPL) thickness with the risk of  PIRA.                                          

• Lower pRNFL (hazard ratio [HR], 1.6 per 5μm; 95% CI, 1.1 to 1.8; P<.001) and GCIPL thickness at diagnosis (HR, 1.7 per 5μm; 95% CI, 1.3 to 3.1; P<.001) were independent predictors of PIRA.
• Including retinal thickness in the multivariate model improved predictive accuracy for PIRA from 48% to 62% (P<.001).
• First-line use of HE-DMTs significantly decreased the risk of PIRA (HR, 0.69; 95% CI, 0.41 to 0.97; P=.027).