Retinal layer thinning predicts treatment failure in relapsing multiple sclerosis.

Area of Science:

• Ophthalmology
• Neurology
• Biomarkers

Background:

• Peripapillary retinal nerve fiber layer (pRNFL) and macular ganglion cell plus inner plexiform layer (GCIPL) thinning are indicators of neuroaxonal damage in multiple sclerosis (MS).
• Disease-modifying treatments (DMTs) can slow this degeneration.

Purpose of the Study:

• To assess the predictive value of pRNFL and GCIPL thinning for DMT failure in relapsing MS (RMS).

Main Methods:

• A 4-year prospective observational study involving 113 RMS patients.
• pRNFL and GCIPL were measured at DMT initiation and at 12 (M12) and 24 (M24) months.
• Treatment failure was defined by confirmed Expanded Disability Status Scale (EDSS) progression and/or Symbol Digit Modalities Test (SDMT) worsening.

Main Results:

• GCIPL thinning >0.5 μm/year at M24 was a strong predictor of treatment failure (HR: 4.5, p < 0.001).
• GCIPL thinning >0.5 μm at M12 also predicted failure (OR: 3.9, p < 0.001).
• pRNFL thinning ≥2 μm/year at M24 showed predictive value (OR: 3.7, p = 0.023), but pRNFL at M12 did not.

Conclusions:

• GCIPL thinning, and to a lesser extent pRNFL thinning, can predict disability progression following DMT initiation in RMS.
• These retinal layer measurements may serve as accessible biomarkers for predicting DMT failure in RMS.