Abstract
We aimed to assess the efficacy of biologic therapy in refractory non-Multiple Sclerosis (MS) Optic Neuritis (ON), a condition more infrequent, chronic and severe than MS ON. This was an open-label multicenter study of patients with non-MS ON refractory to systemic corticosteroids and at least one conventional immunosuppressive drug. The main outcomes were Best Corrected Visual Acuity (BCVA) and both Macular Thickness (MT) and Retinal Nerve Fiber Layer (RNFL) using Optical Coherence Tomography (OCT). These outcome variables were assessed at baseline, 1 week, and 1, 3, 6 and 12 months after biologic therapy initiation. Remission was defined as the absence of ON symptoms and signs that lasted longer than 24 h, with or without an associated new lesion on magnetic resonance imaging with gadolinium contrast agents for at least 3 months. We studied 19 patients (11 women/8 men; mean age, 34.8 ± 13.9 years). The underlying diseases were Bechet’s disease (n = 5), neuromyelitis optica (n = 3), systemic lupus erythematosus (n = 2), sarcoidosis (n = 1), relapsing polychondritis (n = 1) and anti-neutrophil cytoplasmic antibody -associated vasculitis (n = 1). It was idiopathic in 6 patients. The first biologic agent used in each patient was: adalimumab (n = 6), rituximab (n = 6), infliximab (n = 5) and tocilizumab (n = 2). A second immunosuppressive drug was simultaneously used in 11 patients: methotrexate (n = 11), azathioprine (n = 2), mycophenolate mofetil (n = 1) and hydroxychloroquine (n = 1). Improvement of the main outcomes was observed after 1 year of therapy when compared with baseline data: mean ± SD BCVA (0.8 ± 0.3 LogMAR vs. 0.6 ± 0.3 LogMAR; p = 0.03), mean ± SD RNFL (190.5 ± 175.4 μm vs. 183.4 ± 139.5 μm; p = 0.02), mean ± SD MT (270.7 ± 23.2 μm vs. 369.6 ± 137.4 μm; p = 0.03). Besides, the median (IQR) prednisone-dose was also reduced from 40 (10–61.5) mg/day at baseline to. 2.5 (0–5) mg/day after one year of follow-up; p = 0.001. After a mean ± SD follow-up of 35 months, 15 patients (78.9%) achieved ocular remission, and 2 (10.5%) experienced severe adverse events. Biologic therapy is effective in patients with refractory non-MS ON.
Highlights
Optic neuritis (ON) is an acute inflammatory optic neuropathy that may be associated with dramatic visual loss and an important decrease in quality of life in absence of an adequate treatment
Both developed anti-drug antibodies and tachyphylaxis after 36 and 5 months of treatment. They were switched to TCZ achieving complete remission. Biologic therapy with both anti-TNFα (ADA, IFX) and non-anti-TNFα (RTX, TCZ) drugs was useful in patients with non-Multiple Sclerosis (MS) Optic Neuritis (ON) refractory to systemic glucocorticoids and at least one conventional immunosuppressive drug
About 20% of patients with non-MS ON are refractory to conventional immunosuppressive drugs [54]
Summary
Optic neuritis (ON) is an acute inflammatory optic neuropathy that may be associated with dramatic visual loss and an important decrease in quality of life in absence of an adequate treatment. Multiple Sclerosis (MS) ON, the most common form of presentation, is characterized by unilateral acute retroocular pain and visual loss, more commonly observed in Caucasian women between 18 and 50 years [1]. Non-MS ON may have atypical features such as male gender, age less than 18 or greater than 50 years, absence of pain and bilateral presentation [5]. The visual outcome can be devastating, causing a severe visual loss, and even with adequate treatment, many patients may worsen over months [7,8,9,10]
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