BACKGROUND Patients with multiple sclerosis (MS) experience progressive thinning in optical coherence tomography (OCT) measures of neuroaxonal structure regardless of optic neuritis history. Few prospective studies have investigated the effects of disease-modifying therapies on neuroaxonal degeneration in the retina. Alemtuzumab is a monoclonal antibody shown to be superior to interferon β-1a in treating relapsing-remitting MS (RRMS). The purpose of this study was to assess the effects of alemtuzumab and first-line injectable treatments on OCT measures of neuroaxonal structure including peripapillary retinal nerve fiber layer (RNFL) thickness and combined ganglion cell-inner plexiform (GCIP) layer volume in RRMS patients followed up over 5 years. METHODS In this retrospective pilot study with prospectively collected double cohort data, spectral domain OCT measures of RNFL thickness and GCIP volume were compared between alemtuzumab-treated RRMS patients (N = 24) and RRMS patients treated with either interferon-β or glatiramer acetate (N = 21). RESULTS Over a median of 60 months (range 42-60 months), the alemtuzumab cohort demonstrated a change in the mean RNFL thickness (thinning from baseline) of -0.88 μm (95% confidence interval [CI] -2.63 to 0.86; P = 0.32) and mean GCIP volume of +0.013 mm (95% CI -0.006 to 0.032; P = 0.18). Over the same time period, the first-line therapy-treated cohort demonstrated greater degrees of RNFL thinning (mean change in RNFL thickness was -3.65 μm [95% CI -5.40 to -1.89; P = 0.0001]). There was also more prominent GCIP volume loss relative to baseline in the first-line therapy group (-0.052 mm [95% CI -0.070 to -0.034; P < 0.0001]). CONCLUSIONS Alemtuzumab-treated patients with RRMS demonstrated relative stability of OCT-measured neuroaxonal structure compared with RRMS patients treated with either interferon-β or glatiramer acetate over a 5-year period. These findings, along with previous demonstration of improved brain atrophy rates, suggest that alemtuzumab may offer long-term preservation of neuroaxonal structure in patients with RRMS.

中文翻译：

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治疗Alemtuzumab复发缓解型多发性硬化症患者的神经轴突结构的长期稳定性。

背景技术与视神经炎病史无关，患有多发性硬化症（MS）的患者在神经轴突结构的光学相干断层扫描（OCT）测量中经历逐渐变薄。很少有前瞻性研究调查了疾病改良疗法对视网膜神经轴索变性的影响。Alemtuzumab是一种单克隆抗体，在治疗复发缓解型MS（RRMS）方面优于干扰素β-1a。这项研究的目的是评估Alemtuzumab和一线注射治疗对包括ROC患者的视神经乳突结构的OCT测量的影响，包括围乳头周围视网膜神经纤维层（RNFL）厚度和神经节细胞内网状复合体（GCIP）层体积超过5年。方法在这项前瞻性研究中，前瞻性收集了双重队列数据，比较了Alemtuzumab治疗的RRMS患者（N = 24）和接受干扰素-β或醋酸格拉替雷治疗的RRMS患者（N = 21）的光谱域OCT测量RNFL厚度和GCIP体积。结果在60个月的中位值（42-60个月）中，阿仑单抗组的平均RNFL厚度（从基线变薄）变化为-0.88μm（95％置信区间[CI] -2.63至0.86； P = 0.32）和平均GCIP体积+0.013毫米（95％CI -0.006至0.032; P = 0.18）。在同一时间段内，一线治疗治疗的人群表现出更大程度的RNFL变薄（RNFL厚度的平均变化为-3.65μm[95％CI -5.40至-1.89； P = 0.0001]）。与一线治疗组相比，相对于基线，GCIP体积损失也更明显（-0.052 mm [95％CI -0.070至-0.034； P <0.0001]）。结论在5年的时间里，用Alemtuzumab治疗的RRMS患者与用干扰素-β或醋酸格拉替雷治疗的RRMS患者相比，OCT测量的神经轴突结构具有相对稳定性。这些发现以及先前对改善脑萎缩率的证明表明，Alemtuzumab可以长期保护RRMS患者的神经轴突结构。