Cerebrospinal fluid detection of interleukin-1β in phase of remission predicts disease progression in multiple sclerosis

Background: Absence of clinical and radiological activity in relapsing-remitting multiple sclerosis (RRMS) is perceived as disease remission. We explored the role of persisting inflammation during remission in disease evolution. Methods: Cerebrospinal fluid (CSF) levels of interleukin 1 beta (IL-1 beta), a major proinflammatory cytokine, were measured in 170 RRMS patients at the time of clinical and radiological remission. These patients were then followed up for at least 4 years, and clinical, magnetic resonance imaging (MRI) and optical coherence tomography (OCT) measures of disease progression were recorded. Results: Median follow-up of RRMS patients was 5 years. Detection of CSF IL-1 beta levels at the time of remission did not predict earlier relapse or new MRI lesion formation. Detection of IL-1 beta in the CSF was instead associated with higher progression index (PI) and Multiple Sclerosis Severity Scale (MSSS) scores at follow-up, and the number of patients with sustained Expanded Disability Status Scale (EDSS) or Multiple Sclerosis Functional Composite worsening at follow-up was higher in individuals with detectable levels of IL-1 beta. Patients with undetectable IL-1 beta in the CSF had significantly lower PI and MSSS scores and a higher probability of having a benign MS phenotype. Furthermore, patients with undetectable CSF levels of IL-1 beta had less retinal nerve fiber layer thickness and macular volume alterations visualized by OCT compared to patients with detectable IL-1 beta. Conclusions: Our results suggest that persistence of a proinflammatory environment in RRMS patients during clinical and radiological remission influences midterm disease progression. Detection of IL-1 beta in the CSF at the time of remission appears to be a potential negative prognostic factor in RRMS patients.