Abstract Details

Title Addition of optic nerve involvement to dissemination in space criteria for multiple sclerosis – the value of optical coherence tomography

Topic Multiple Sclerosis

Presentation(s) S46 - MS Therapeutics and Clinical Decision Making (2:36 PM-2:48 PM)

Poster/Presentation
Number 009

Background The optic nerve has been recommended as an additional region for demonstrating dissemination in space (DIS) in diagnostic criteria for multiple sclerosis (MS).

Objective

To investigate the effect of adding the optic nerve region as determined by OCT as part of the DIS criteria to improve the 2017 diagnostic criteria.

Design/Methods

From a prospective observational study, we included patients with a first demyelinating event who had complete information to assess DIS and a spectral-domain OCT scan obtained within 90 days. Modified DIS (modDIS) criteria were constructed by adding the optic nerve to the current DIS regions based on validated thresholds for OCT inter-eye differences. The DIS and modDIS criteria were evaluated with univariable Cox proportional hazard regression analyses with the time to the second attack as the outcome. A subset of these patients who had at least 3 years of follow-up were selected to assess the diagnostic performance. Subgroup analyses were performed distinguishing ON vs. non-ON at first demyelinating event.

Results

We analyzed 231 MS patients (mean age 30.3 years [SD 8.1], 74% female) during a median observation period of 61 months (range: 12 - 93).

Adding the optic nerve as a fifth region improved the diagnostic performance by slightly increasing the accuracy (2017 DIS 75.5%, modDIS 78.1%) and the sensitivity (2017 DIS 79.2%, modDIS 82.3%) without lowering the specificity (2017 DIS 52.4%, modDIS 52.4%). When the analysis was conducted according to CIS topography, the modDIS criteria performed similarly in both optic neuritis and non–optic neuritis CIS.

Conclusions Addition of the optic nerve, assessed by OCT, as a fifth region in the current DIS criteria moderately improves diagnostic performance by increasing sensitivity without lowering specificity.

Authors/Disclosures
Gabriel Bsteh, MD (Medical University Vienna, Department of Neurology) PRESENTER	Dr. Bsteh has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Biogen. Dr. Bsteh has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Celgene-BMS. Dr. Bsteh has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novartis. Dr. Bsteh has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Roche. Dr. Bsteh has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Teva. Dr. Bsteh has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Sanofi Genzyme.
Harald Hegen, MD	Dr. Hegen has nothing to disclose.
Patrick Altmann (Univ.-Klinik für Neurologie)	The institution of Mr. Altmann has received research support from Quanterix. The institution of Mr. Altmann has received research support from Biogen, Merck, Roche, Sanofi, Teva,. Mr. Altmann has received intellectual property interests from a discovery or technology relating to health care.
Michael Auer	Michael Auer has nothing to disclose.
Klaus Berek	No disclosure on file
Franziska Di Pauli	Franziska Di Pauli has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Novartis. Franziska Di Pauli has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Teva. Franziska Di Pauli has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Jannsen. Franziska Di Pauli has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Sanofi. Franziska Di Pauli has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Roche. Franziska Di Pauli has received personal compensation in the range of $500-$4,999 for serving as a Consultant for BMS. Franziska Di Pauli has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Merck. Franziska Di Pauli has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for horizon. Franziska Di Pauli has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis. Franziska Di Pauli has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for merck. Franziska Di Pauli has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Jannsen. Franziska Di Pauli has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Sanofi. The institution of Franziska Di Pauli has received research support from Roche.
Barbara Kornek, MD (University of Vienna)	Dr. Kornek has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biogen. Dr. Kornek has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for BMS Celgene. Dr. Kornek has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Johnson&Johnson. Dr. Kornek has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis. Dr. Kornek has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Merck. Dr. Kornek has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Sanofi-Genzyme. The institution of Dr. Kornek has received research support from Novartis.
Nik Krajnc	No disclosure on file
Fritz Leutmezer	Fritz Leutmezer has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Almirall, Biogen, Celgene, Johnson&Johnson, Novartis, Merck, Roche, Sanofi, Teva-Ratiopharm. Fritz Leutmezer has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Almirall, Biogen, Celgene, Johnson&Johnson, Novartis, Merck, Roche, Sanofi, Teva-Ratiopharm. Fritz Leutmezer has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Almirall, Biogen, Celgene, Johnson&Johnson, Novartis, Merck, Roche, Sanofi, Teva-Ratiopharm. The institution of Fritz Leutmezer has received research support from Biogen, Merck, Novartis, Roche.
Stefan Macher	No disclosure on file
Paulus S. Rommer (AKH Wien / Univ. Klinik Fuer Neurologie)	Dr. Rommer has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Alexion. Dr. Rommer has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Roche. Dr. Rommer has received personal compensation in the range of $500-$4,999 for serving as a Consultant for biogen. The institution of Dr. Rommer has received personal compensation in the range of $500-$4,999 for serving as a Consultant for celgene. The institution of Dr. Rommer has received personal compensation in the range of $500-$4,999 for serving as a Consultant for merck. Dr. Rommer has received personal compensation in the range of $0-$499 for serving as a Consultant for sanofi. Dr. Rommer has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for sandoz. Dr. Rommer has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Abbvie. Dr. Rommer has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for almirall. Dr. Rommer has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for biogen. Dr. Rommer has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Novartis. Dr. Rommer has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Merck. The institution of Dr. Rommer has received research support from merck. The institution of Dr. Rommer has received research support from roche. The institution of Dr. Rommer has received research support from amicus. The institution of Dr. Rommer has received research support from biogen.
Karin Zebenholzer, MD (University Clinic for Neurology)	Dr. Zebenholzer has nothing to disclose.
Gudrun Zulehner	No disclosure on file
Tobias Zrzavy	Tobias Zrzavy has nothing to disclose.
Florian Deisenhammer, MD	Dr. Deisenhammer has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion. Dr. Deisenhammer has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Almirall. Dr. Deisenhammer has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biogen. Dr. Deisenhammer has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for BMS/Celgene. Dr. Deisenhammer has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Sanofi/Genzyme. Dr. Deisenhammer has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Merck. Dr. Deisenhammer has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis. Dr. Deisenhammer has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche. Dr. Deisenhammer has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Almirall. Dr. Deisenhammer has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Biogen. Dr. Deisenhammer has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Celgene. Dr. Deisenhammer has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Genzyme. Dr. Deisenhammer has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Merck. Dr. Deisenhammer has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Novartis. Dr. Deisenhammer has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Roche. Dr. Deisenhammer has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for SOBI.
Berthold Pemp, MD (Medical University of Vienna)	Dr. Pemp has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Chiesi. Dr. Pemp has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Chiesi. Dr. Pemp has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for GenSight. The institution of Dr. Pemp has received research support from Chiesi.
Thomas A. Berger, MD (Dept. of Neurology, Medical University of Vienna)	Prof. Berger has received personal compensation in the range of $10,000-$49,999 for serving as a speaker at scientific meetings and participant of local and international advisory boards with various companies producing and markerting treatments for multiple sclerosis (Almirall, Biogen, Biologix, Bionorica, Celgene-BMS, Merck, Novartis, Roche, Sanofi-Genzyme, TG Therapeutics, UCB).