Visual outcome is similar in optic neuritis patients treated with oral and i.v. high-dose methylprednisolone: a retrospective study on 56 patients

Background: Plasma exchange (PE) is often considered as an effective treatment for neuromyelitis optica spectrum disorder (NMOSD) and several inflammatory demyelinating disorders of the central nervous system. This study aimed to evaluate the visual outcomes of Chinese patients with severe acute isolated optic neuritis (ON) who received PE therapy after high-dose intravenous methylprednisolone (IVMP) treatment. Methods: Thirty-seven acute isolated ON patients experiencing their first attack of severe visual impairment without neurological disability were recruited. All subjects received five cycles of double-filtration plasmapheresis. Visual acuity (VA) was documented at onset, 1 day before PE treatment, at each cycle of PE therapy and at the 1-month follow-up visit. Results: This study included 26 female (70.3%) and 11 male (29.7%) subjects, and 18 subjects (48.6%) had bilateral involvement. The time window between onset and PE treatment was 27.3 ± 12.7 days (range: 6–53 days). Mean VA (logMAR) of the studied eyes at onset, 1-day before PE treatment/after IVMP and after the fifth PE treatment were 3.41 ± 1.50, 2.61 ± 1.64 and 1.66 ± 1.52, respectively ( p < 0.001). Nineteen eyes (51.4%) showed no light perception at the onset, and 17 eyes (45.9%) improved to Snellen VA >20/800 after IVMP and PE treatments, among which five eyes (13.5%) recovered to Snellen VA 20/20 ( p < 0.001). Predictors of good visual outcome included body mass index [odds ratio (OR) = 0.734, p = 0.044], serum AQP4 antibody-positive status (OR = 0.004, p = 0.001), bilaterality (OR = 0.042, p = 0.008) and time window from onset to PE therapy per 1 day (OR = 0.79, p = 0.002). Conclusion: This study revealed that PE treatment effectively improves the visual outcomes of patients experiencing their first attack of severe acute isolated ON after high-dose IVMP treatment. Better visual outcomes can be achieved with early PE treatment.

Download Full-text

Immunological effects of oral high-dose methylprednisolone treatment of acute optic neuritis and multiple sclerosis

Journal of Neuroimmunology ◽

10.1016/s0165-5728(98)91768-4 ◽

1998 ◽

Vol 90 (1) ◽

pp. 98 ◽

Cited By ~ 1

Author(s):

F. Sellebjerg ◽

M. Christiansen ◽

J. Jensen ◽

J.L. Frederiksen

Keyword(s):

Multiple Sclerosis ◽

Optic Neuritis ◽

High Dose ◽

Acute Optic Neuritis ◽

High Dose Methylprednisolone ◽

Methylprednisolone Treatment ◽

Immunological Effects

Download Full-text

The retrospective study evaluating the outcomes of high‐dose methylprednisolone pulse therapy for 483 moderate‐to‐severe alopecia areata patients

British Journal of Dermatology ◽

10.1111/bjd.20644 ◽

2021 ◽

Author(s):

M. Wada‐Irimada ◽

M. Mizuashi ◽

T. Takahashi ◽

G. Tojo ◽

K. Onami ◽

...

Keyword(s):

Retrospective Study ◽

Alopecia Areata ◽

Pulse Therapy ◽

Methylprednisolone Pulse Therapy ◽

High Dose ◽

Methylprednisolone Pulse ◽

High Dose Methylprednisolone

Download Full-text

Immunological effects of oral high-dose methylprednisolone in acute optic neuritis and multiple sclerosis

European Journal of Neurology ◽

10.1046/j.1468-1331.2000.00074.x ◽

2000 ◽

Vol 7 (3) ◽

pp. 281-289 ◽

Cited By ~ 42

Author(s):

F. Sellebjerg ◽

M. Christiansen ◽

J. Jensen ◽

J. L. Frederiksen

Keyword(s):

Multiple Sclerosis ◽

Optic Neuritis ◽

High Dose ◽

Acute Optic Neuritis ◽

High Dose Methylprednisolone ◽

Immunological Effects

Download Full-text

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

Neurology Neuroimmunology & Neuroinflammation ◽

10.1212/nxi.0000000000000572 ◽

2019 ◽

Vol 6 (4) ◽

pp. e572 ◽

Cited By ~ 30

Author(s):

Hadas Stiebel-Kalish ◽

Mark Andrew Hellmann ◽

Michael Mimouni ◽

Friedemann Paul ◽

Omer Bialer ◽

...

Keyword(s):

Retrospective Study ◽

Optic Neuritis ◽

Early Treatment ◽

Roc Analysis ◽

High Dose ◽

Visual Recovery ◽

Visual Disability ◽

Optimal Criterion

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.

Download Full-text