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July 2019; 6 (4) ArticleOpen Access

Does time equal vision in the acute treatment of a cohort of AQP4 and MOG optic neuritis?

Hadas Stiebel-Kalish, Mark Andrew Hellmann, Michael Mimouni, Friedemann Paul, Omer Bialer, Michael Bach, Itay Lotan
First published May 21, 2019, DOI: https://doi.org/10.1212/NXI.0000000000000572
Hadas Stiebel-Kalish
From the Sackler School of Medicine (H.S.-K., M.A.H., O.B., I.L.), Tel Aviv University; Neuro-Ophthalmology Unit (H.S.-K., O.B.), Department of Ophthalmology, Rabin Medical Center; Neuro-Immunology Service and Department of Neurology (M.A.H., I.L.), Rabin Medical Center, Petah Tikva; Department of Ophthalmology (M.M.), Rambam Health Care Campus, and Ruth Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel; NeuroCure Clinical Research Center and Experimental and Clinical Research Center (F.P.), Max Delbrueck Center for Molecular Medicine, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; and Eye Center (M.B.), Medical Center, University of Freiburg and Faculty of Medicine, University of Freiburg, Germany.
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Mark Andrew Hellmann
From the Sackler School of Medicine (H.S.-K., M.A.H., O.B., I.L.), Tel Aviv University; Neuro-Ophthalmology Unit (H.S.-K., O.B.), Department of Ophthalmology, Rabin Medical Center; Neuro-Immunology Service and Department of Neurology (M.A.H., I.L.), Rabin Medical Center, Petah Tikva; Department of Ophthalmology (M.M.), Rambam Health Care Campus, and Ruth Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel; NeuroCure Clinical Research Center and Experimental and Clinical Research Center (F.P.), Max Delbrueck Center for Molecular Medicine, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; and Eye Center (M.B.), Medical Center, University of Freiburg and Faculty of Medicine, University of Freiburg, Germany.
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Michael Mimouni
From the Sackler School of Medicine (H.S.-K., M.A.H., O.B., I.L.), Tel Aviv University; Neuro-Ophthalmology Unit (H.S.-K., O.B.), Department of Ophthalmology, Rabin Medical Center; Neuro-Immunology Service and Department of Neurology (M.A.H., I.L.), Rabin Medical Center, Petah Tikva; Department of Ophthalmology (M.M.), Rambam Health Care Campus, and Ruth Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel; NeuroCure Clinical Research Center and Experimental and Clinical Research Center (F.P.), Max Delbrueck Center for Molecular Medicine, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; and Eye Center (M.B.), Medical Center, University of Freiburg and Faculty of Medicine, University of Freiburg, Germany.
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Friedemann Paul
From the Sackler School of Medicine (H.S.-K., M.A.H., O.B., I.L.), Tel Aviv University; Neuro-Ophthalmology Unit (H.S.-K., O.B.), Department of Ophthalmology, Rabin Medical Center; Neuro-Immunology Service and Department of Neurology (M.A.H., I.L.), Rabin Medical Center, Petah Tikva; Department of Ophthalmology (M.M.), Rambam Health Care Campus, and Ruth Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel; NeuroCure Clinical Research Center and Experimental and Clinical Research Center (F.P.), Max Delbrueck Center for Molecular Medicine, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; and Eye Center (M.B.), Medical Center, University of Freiburg and Faculty of Medicine, University of Freiburg, Germany.
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Omer Bialer
From the Sackler School of Medicine (H.S.-K., M.A.H., O.B., I.L.), Tel Aviv University; Neuro-Ophthalmology Unit (H.S.-K., O.B.), Department of Ophthalmology, Rabin Medical Center; Neuro-Immunology Service and Department of Neurology (M.A.H., I.L.), Rabin Medical Center, Petah Tikva; Department of Ophthalmology (M.M.), Rambam Health Care Campus, and Ruth Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel; NeuroCure Clinical Research Center and Experimental and Clinical Research Center (F.P.), Max Delbrueck Center for Molecular Medicine, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; and Eye Center (M.B.), Medical Center, University of Freiburg and Faculty of Medicine, University of Freiburg, Germany.
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Michael Bach
From the Sackler School of Medicine (H.S.-K., M.A.H., O.B., I.L.), Tel Aviv University; Neuro-Ophthalmology Unit (H.S.-K., O.B.), Department of Ophthalmology, Rabin Medical Center; Neuro-Immunology Service and Department of Neurology (M.A.H., I.L.), Rabin Medical Center, Petah Tikva; Department of Ophthalmology (M.M.), Rambam Health Care Campus, and Ruth Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel; NeuroCure Clinical Research Center and Experimental and Clinical Research Center (F.P.), Max Delbrueck Center for Molecular Medicine, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; and Eye Center (M.B.), Medical Center, University of Freiburg and Faculty of Medicine, University of Freiburg, Germany.
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Itay Lotan
From the Sackler School of Medicine (H.S.-K., M.A.H., O.B., I.L.), Tel Aviv University; Neuro-Ophthalmology Unit (H.S.-K., O.B.), Department of Ophthalmology, Rabin Medical Center; Neuro-Immunology Service and Department of Neurology (M.A.H., I.L.), Rabin Medical Center, Petah Tikva; Department of Ophthalmology (M.M.), Rambam Health Care Campus, and Ruth Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel; NeuroCure Clinical Research Center and Experimental and Clinical Research Center (F.P.), Max Delbrueck Center for Molecular Medicine, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; and Eye Center (M.B.), Medical Center, University of Freiburg and Faculty of Medicine, University of Freiburg, Germany.
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Citation
Does time equal vision in the acute treatment of a cohort of AQP4 and MOG optic neuritis?
Hadas Stiebel-Kalish, Mark Andrew Hellmann, Michael Mimouni, Friedemann Paul, Omer Bialer, Michael Bach, Itay Lotan
Neurol Neuroimmunol Neuroinflamm Jul 2019, 6 (4) e572; DOI: 10.1212/NXI.0000000000000572

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Abstract

Objective To investigate whether visual disability which is known to accumulate by poor recovery from optic neuritis (ON) attacks can be lessened by early treatment, we investigated whether the time from symptom onset to high-dose IV methylprednisolone (IVMP) affected visual recovery.

Methods A retrospective study was performed in a consecutive cohort of patients following their first aquaporin-4 (AQP4)-IgG or myelin oligodendrocyte glycoprotein (MOG)-IgG-ON. Best-corrected visual acuity (BCVA) in ON eyes at 3 months (BCVA3mo) was correlated with time to IVMP (days). In cases of bilateral ON, 1 eye was randomly selected.

Results A total of 29 of 37 patients had ON (27 AQP4-seropositive neuromyelitis optica spectrum disorder [NMOSD] and 9 MOG-IgG-ON), 2 of whom refused treatment. Of the 27 patients included, 10 presented later than 7 days from onset. The median BCVA3mo of patients treated >7 days was 20/100 (interquartile range 20/100–20/200). Patients treated >7 days had an OR of 5.50 (95% CI 0.88–34.46, p = 0.051) of failure to regain 0.0 logMAR vision (20/20) and an OR of 10.0 (95% CI 1.39–71.9) of failure to regain 0.2 logMAR vision (20/30) (p = 0.01) compared with patients treated within 7 days. ROC analysis revealed that the optimal criterion of delay in IVMP initiation was ≤4 days, with a sensitivity and specificity of 71.4% and 76.9%, respectively.

Conclusions In this retrospective study of ON with AQP4 and MOG-IgG, even a 7-day delay in IVMP initiation was detrimental to vision. These results highlight the importance of early treatment for the long-term visual recovery in this group of patients. A prospective, multicenter study of the effects of timing of IVMP is currently underway.

Classification of evidence This study provides Class IV evidence that hyperacute treatment of AQP4 and MOG-ON with IVMP increases the chance for good visual recovery (20/20 vision) and that even a greater than 7-day delay in treatment is associated with a higher risk for poor visual recovery.

Glossary

AON=
autoimmune optic neuritis;
AQP=
aquaporin;
AUC=
area under the curve;
BCVA=
best-corrected visual acuity;
IA=
immunoadsorption;
IVMP=
IV methylprednisolone;
MOG=
myelin oligodendrocyte glycoprotein;
OCT=
optical coherence tomography;
ON=
optic neuritis;
ONTT=
Optic Neuritis Treatment Trial;
PE=
plasma exchange;
RGC=
retinal ganglion cell;
VA=
visual acuity

Footnotes

  • Funding information and disclosures are provided at the end of the article. Full disclosure form information provided by the authors is available with the full text of this article at Neurology.org/NN.

  • The Article Processing Charge was funded by the authors.

  • Class of Evidence: NPub.org/coe

  • Received December 10, 2018.
  • Accepted in final form March 8, 2019.
  • Copyright © 2019 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology.

This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License 4.0 (CC BY-NC-ND), which permits downloading and sharing the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

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