The retinal layer shows the severity of the multiple sclerosis. To declare it is a research carried out by MedUni Vienna who for the first time stated that the retina can be used as a prognostic marker. Analyzes revealed that thinning of the retinal layer following a multiple sclerosis relapse predicts the severity of future relapses and, therefore, the likelihood of disability.
It is vital to know the severity of multiple sclerosis (MS) in order to choose the appropriate treatment measures, but this, until recently, cannot be done reliably using existing methods.
The results of the study have been published in the scientific journal Neurology.
The team of scientists coordinated by Gabriel Bsteh And Thomas Berger of the Department of Neurology of the MedUni Vienna / University Hospital Viennain collaboration with the Department of Ophthalmology and Optometry of the MedUni Vienna / University Hospital Viennaobserved 167 patients diagnosed with multiple sclerosis over a period of more than three years.
The researchers speculated that the damage to the retina with particular regard to the retinal layer due to the relapse reflects the extent of the damage in the brain. As confirmed by scientific analyzes, the loss of approx 5 µm (micrometers) of retinal layer thickness after optic neuritis equates to a doubling of the risk of permanent disability after the subsequent relapse.
The team of scientists used nettle coherence tomography (OCT) technology to measure the thickness of the retinal layer. OCT is an inaging technique that uses infrared light to produce high-resolution three-dimensional images of very thin layers of tissue in the micrometer range (1 micrometer = 1 thousandth of a millimeter). This technique is already available as a tool for diagnosing eye diseases such as glaucoma and for assessing disease progression.
“In the thickness of the retinal layer, we found a new biomarker that represents a window into the brain, so to speak,” concluded Gabriel Bsteh, summing up the essence of the study. If the results were confirmed in larger follow-up studies, the technique could also be applied in routine clinical practice.
As for Italy, every year the new diagnoses of multiple sclerosis are around 3,600 cases. Land affected people are in total about 133 thousand, with a double prevalence in women than in men. The relapsing-remitting form represents about 85% of all cases and is distinguished by the alternation of attacks or relapses, of unpredictable duration, characterized by the onset of sudden neurological symptoms and phases of complete or partial remission.
Professor Luigi Maria Grimaldi, Head of the Neurology Unit of the San Raffaele Giglio Hospital in Cefalù, said: “Multiple sclerosis is one of the most common neurodegenerative diseases. It is a disease in which the immune system attacks myelin, the protective sheath that covers the nerve fibers, causing neurological deficits. In the Old Continent it involves 700 thousand people for a total of over 2.5 million patients all over the world “.
“Symptoms are difficult to interpret as they are common to other diseases or conditions. It may therefore happen that the path to reach the diagnosis is sometimes long and complex. The neurological damage linked to demyelination is mostly irreversible ”.
“Hence the need to have available therapies, such as ozanimod, effective from the early stages of the disease and well tolerated by the majority of patients – added Professor Diego Centonze, Director of the Complex Operational Unit of Neurology and of the Stroke Unit at IRCCS Neuromed, in Pozzilli (Isernia), Professor of Neurology at the University of Rome Tor Vergata and first author of the study -. Ozanimod acts by modulating the immune response by interacting with the sphingosine 1-phosphate receptors in particular on the isotypes most involved in the modulation of the immune response and in the repair of myelin damage “.
Regarding the effectiveness of ozanimod: “In this exploratory analysis we analyzed 1,501 men and women: 71% were naive while the remaining 29% had already received therapy – he specified Centonze, first author of this analysis -. The aim was to evaluate long-term clinical and radiological outcomes (OLE-DAYBREAK study) in patients who are naive or experienced in previous disease modification therapy (DMT). In the pivotal phase 3 studies, the benefit associated with the early use of ozanimod was consistent regardless of previous exposure to a DMT and persisted over time, with an improving trend ”.
“The data from this long-term observational study on patients treated with ozanimod 0.92 mg for 5-6 years show sustained control of disease activity. The data recorded between the two groups of patients were substantially comparable and therefore both benefited from the treatment. Safety data also go in this direction and therefore the drug does not cause excessive side effects. This too was found both when it was administered as a first therapeutic option and in patients already treated with other types of treatments “.
“The pathology can lead to a significant and irreversible loss of brain volume as well as to an alteration of cognitive functions if there is no timely therapeutic intervention – added prof. Luigi Maria Grimaldi. – The data presented at the EAN showed the action of ozanimod in preserving or improving cognitive functions in most of the patients examined. In fact, in the SUNBEAM study and its extension (OLE-DAYBREAK), patients characterized by higher brain volumes at baseline, in particular thalamic volume, had a better performance on cognitive tests (symbol digit modalities test – SDMT) than patients with lower volumes “.
“This trend remained stable or improved over 4-5 years of treatment with ozanimod, which was associated with preserved or improved cognitive function in approximately 80% of patients with higher thalamic volume and in 66% of patients with lower brain. We now have comforting data on the use of the new therapy for over four years, especially on the protective role it plays against cognitive decline and brain atrophy ”.
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