RT Journal Article
SR Electronic
T1 Does time equal vision in the acute treatment of a cohort of AQP4 and MOG optic neuritis?
JF Neurology - Neuroimmunology Neuroinflammation
JO Neurol Neuroimmunol Neuroinflamm
FD Lippincott Williams & Wilkins
SP e572
DO 10.1212/NXI.0000000000000572
VO 6
IS 4
A1 Hadas Stiebel-Kalish
A1 Mark Andrew Hellmann
A1 Michael Mimouni
A1 Friedemann Paul
A1 Omer Bialer
A1 Michael Bach
A1 Itay Lotan
YR 2019
UL http://nn.neurology.org/content/6/4/e572.abstract
AB 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.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