Macular ganglion cell-inner plexiform layer thinning as a biomarker of disability progression in relapsing multiple
Gabriel Bsteh1, Klaus Berek2, Harald Hegen2
1Department of Neurology, Medical University of Vienna, Vienna, Austria.
Background:
Macular ganglion cell-inner plexiform layer (mGCIPL) is an emerging biomarker of neuroaxonal degeneration in multiple sclerosis (MS).
Objective:
We aimed to determine cut-off values of mGCIPL thinning for discriminating between progressing and stable patients in relapsing multiple sclerosis (RMS).
Methods:
This is a 3-year prospective longitudinal study on 183 RMS patients with annual optical coherence tomography. Best possible cut-off values of baseline mGCIPL and annual loss of macular ganglion cell-inner plexiform layer (aLmGCIPL) for discriminating clinically progressing (physical progression or cognitive decline) from stable patients were defined by receiver operating characteristics analysis and tested using multivariate regression models.
Results:
Baseline mGCIPL thickness <77 µm was associated with an increased risk (hazard ratio: 2.7, 95% confidence interval (CI): 1.5-4.7, p < 0.001) of disability progression. An aLmGCIPL cut-off ⩾1 µm accurately identified clinically progressing patients (87% sensitivity at 90% specificity) and was a strong predictor of clinical progression (odds ratio: 18.3, 95% CI: 8.8-50.3).
Conclusion:
We present evidence that cross-sectionally measured mGCIPL thickness and annualized thinning rates of mGCIPL are able to identify clinically progressing RMS with high accuracy.
Insights
Macular ganglion cell-inner plexiform layer (mGCIPL) thinning can identify multiple sclerosis progression. A baseline thickness below 77µm or annual loss of 1µm predicts disability progression in relapsing MS patients.
Area of Science:
- Ophthalmology
- Neurology
- Biomarkers
Background:
- Macular ganglion cell-inner plexiform layer (mGCIPL) is an emerging biomarker for neuroaxonal degeneration in multiple sclerosis (MS).
- Distinguishing between progressing and stable disease courses in relapsing MS (RMS) is crucial for treatment decisions.
Purpose of the Study:
- To establish cut-off values for mGCIPL thickness and thinning rates to differentiate between progressing and stable RMS patients.
- To validate these cut-off values using clinical progression criteria.
Main Methods:
- A 3-year prospective longitudinal study involving 183 RMS patients.
- Annual optical coherence tomography (OCT) scans to measure mGCIPL thickness.
- Receiver operating characteristic (ROC) analysis and multivariate regression models to determine cut-off values.
Main Results:
- Baseline mGCIPL thickness <77µm was associated with a 2.7-fold increased risk of disability progression.
- Annual mGCIPL loss (aLmGCIPL) ≥1µm accurately identified clinically progressing patients with 87% sensitivity and 90% specificity.
- aLmGCIPL was a strong predictor of clinical progression (OR: 18.3).
Conclusions:
- Cross-sectional mGCIPL thickness and annualized thinning rates are accurate indicators for identifying clinically progressing RMS.
- These OCT-derived measurements can aid in monitoring disease activity and guiding therapeutic strategies in MS.
