PHOMS-related disease duration, higher disability in primary progressive MS

Peripapillary hyperreflective ovoid mass-like structures (PHOMS), a new finding in optical coherence tomography (OCT) of the retina in assessing multiple sclerosis (MS), may be associated with disease duration and progression in primary progressive MS (PPMS). , according to study results published in the European Journal of Neurology.

Previous research has identified the presence of PHOMS in patients with advanced MS with a mean disease duration of 20 years. However, there are no data on the development of PHOMS in early MS. The authors of the current study wanted to investigate the incidence of PHOMS in patients diagnosed with early relapsing-remitting multiple sclerosis (RRMS) and see if there was a link between PHOMS and disease progression in patients with PPMS and RRMS.

The study was a cross-sectional analysis of a cohort of patients with previously relapsed MS (RRMS; n = 349) and a second cohort of patients with PPMS (n = 66) and RRMS (n = 65). Patients in the first RRMS cohort had an illness duration of <12 months. Those in the second PPMS cohort were adjusted for disease duration in patients with RRMS.

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Retinal OCT imaging was performed in all patients. A total of 2 experienced, blinded evaluators examined the images to identify the occurrence of PHOMS. In the early RRMS group, approximately 18.3% of the patients (n = 64) had PHOMS. The mean age of these patients was 31 years while the mean illness duration was 1.0 months.

In the second cohort, a total of 12 patients with RRMS and 13 patients with PPMS had PHOMS. The mean ages of these patients were 41 years and 53 years, while the mean disease duration was 1.5 years and 6.5 years, respectively. No associations were found between the occurrence of PHOMS and age, duration of illness and disability.

In the group of patients with PPMS, there were significant associations between the presence of PHOMS and longer disease duration (6.5 years vs. 1.0 years; P = 0.0007) and higher values ​​on the extended disability status scale (EDSS) (4 , 9 vs. 3.5; P = .03). A multiple logistic regression analysis adjusted for EDSS, disease duration, age and gender showed that the disease duration was more relevant for the occurrence of PHOMS (EDDS: odds ratio [OR], 1.33; 95% CI 0.79-2.26; P = .28; Disease duration: OR, 1.17; 95% CI, 1.00-1.40; P = .06).

The limitations of the study included the cross-sectional nature of the analyzes and the lack of data on the activity of inflammatory diseases and their influence on the occurrence of PHOMS.

Based on the results, however, the researchers suggest that “a connection between PHOMS development and disease duration during PPMS is conceivable, while the underlying causes remain unclear”.

Disclosure: Several authors stated links to the pharmaceutical industry. For a full list of the details, see the original article.


Wicklein R, Wauschkuhn J, Giglhuber K, et al. Association of peripapillary hyperreflective egg-shaped mass-like structures and disease duration in primary progressive multiple sclerosis. Eur J Neurol. Published online on August 9, 2021. doi: 10.1111 / de.15056

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