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

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

138 Scopus citations

Abstract

ObjectiveTo 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.MethodsA 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.ResultsA 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.ConclusionsIn 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 evidenceThis 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.

Original languageEnglish
Article numbere572
JournalNeurology: Neuroimmunology and NeuroInflammation
Volume6
Issue number4
DOIs
StatePublished - 1 Jul 2019

Funding

FundersFunder number
Arthur Arnstein Stiftung
Israeli Car Accident Prevention Association
Maratier Foundation
Bayer
Novartis
EMD Serono
Biogen
Teva Pharmaceutical Industries
Guthy-Jackson Charitable Foundation
Bundesministerium für Bildung und Forschung
Shire
Tel Aviv University
MedImmune
Seventh Framework Programme
Stiftung Würth

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