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Abstract
Objective: To retrospectively investigate whether disease-modifying therapies (DMTs) exert differential effects on rates of retinal atrophy in relapsing-remitting multiple sclerosis (RRMS), as assessed using optical coherence tomography (OCT).
Methods: A total of 402 patients with RRMS followed at the Johns Hopkins MS Center who underwent Cirrus-HD OCT were assessed for eligibility. Inclusion criteria included at least 1 year of OCT follow-up and adherence to a single DMT during the period of follow-up. Combined thickness of the ganglion cell + inner plexiform (GCIP) and other retinal layers was computed utilizing automated macular segmentation. Retinal thickness changes were analyzed using mixed-effects linear regression.
Results: The effects of glatiramer acetate (GA; n = 48), natalizumab (NAT; n = 46), and interferon-β-1a subcutaneously (IFNSC; n = 35) and intramuscularly (IFNIM; n = 28) were assessed. Baseline analyses revealed no significant differences between groups in terms of age, sex, optic neuritis history, or follow-up duration. During follow-up, relative to NAT-treated patients, IFNSC- and GA-treated patients exhibited 0.37 μm/y (p < 0.001) and 0.14 μm/y (p = 0.035) faster rates of GCIP thinning, respectively, adjusting for the interval between initiation of DMT and OCT monitoring (gap time), age, sex, relapses, and disease duration. In the IFNSC group, GCIP thinning was 1.53 μm/y faster during the first year of therapy vs during the time interval afterwards (p < 0.001).
Conclusions: Rates of GCIP atrophy in patients with RRMS vary according to DMT utilization. Our findings support OCT for monitoring neurodegenerative treatment effects in the retina, an easily accessible tissue, and as a practical outcome measure in RRMS clinical trials.
GLOSSARY
- AMT=
- average macular thickness;
- DMT=
- disease-modifying therapy;
- GA=
- glatiramer acetate;
- GCIP=
- ganglion cell + inner plexiform layer;
- HC=
- healthy control;
- IFN=
- interferon;
- IFNIM=
- intramuscular interferon-β-1a;
- IFNSC=
- subcutaneous interferon-β-1a;
- INL=
- inner nuclear layer;
- MME=
- microcystic macular edema;
- MS=
- multiple sclerosis;
- NAT=
- natalizumab;
- OCT=
- optical coherence tomography;
- ON=
- optic neuritis;
- ONL=
- outer nuclear layer;
- pRNFL=
- peripapillary retinal nerve fiber layer thickness;
- RRMS=
- relapsing-remitting multiple sclerosis
Footnotes
Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
- Received April 29, 2016.
- Accepted in final form November 10, 2016.
- © 2017 American Academy of Neurology
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