Abstract
Purpose Although oral prednisolone is the first-line treatment for preventing recurrent optic neuritis (ON) after the completion of acute-phase treatment, especially anti-aquaporin 4 (AQP4) antibody-positive ON, and anti-myelin oligodendrocyte glycoprotein (MOG) antibody-positive ON, some patients experience relapses. Immunosuppressants could be effective in reducing the recurrence rate for neuromyelitis optica spectrum disorder and MOG antibody-related diseases, but there have been few studies addressing this issue focusing on the changes in ophthalmic parameters. The objective of the study was to analyze the impact of off-label uses of immunosuppressants to reduce recurrent ON. Design Retrospective observational study, clinical case series. Methods We reviewed the medical charts of 11 cases (22 eyes) who underwent immunosuppressive therapy in Kobe University Hospital and compared the annualized relapse rate (ARR) before and after immunosuppressive therapy. We also evaluated the dosage of prednisolone, complications of immunosuppressants, and other visual functional ophthalmologic parameters. Results Eleven cases in total had AQP4 antibody (9 cases) and/or MOG antibody (3 cases). One case was double positive for these antibodies. Nine patients received azathioprine and two received mycophenolate mofetil as an initial immunosuppressive therapy. The median duration of immunosuppressant treatment was 2.8 years. The median ON ARR before immunosuppressive therapy was 0.33, and this decreased significantly to 0 after the therapy (p = 0.02). The dose of prednisolone was reduced from 17.8 ± 7.1 mg/day before to 5.8 ± 2.2 mg/day after immunosuppressive therapy (p < 0.01). Although two patients presented with mild elevation of liver enzymes and nausea, all patients were able to continue taking the immunosuppressants. Conclusions Immunosuppressants can potentially decrease relapses and steroid dosage in patients with anti-AQP4 or MOG antibody-positive ON without severe adverse events and the exacerbation of visual acuities.
Highlights
A recent epidemiologic survey in Japan revealed that of 531 cases of optic neuritis (ON), 23% tested positive for either anti-aquaporin-4 (AQP4) or anti-myelin oligodendrocyte glycoprotein (MOG) antibodies [1]. e negative both AQP4 and MOG antibodies called as idiopathic ON showed good response to treatment and seldom relapsed [2]
We investigated the effect of offlabel uses of immunosuppressants on the annual recurrence rate (ARR) of ON and changes in ophthalmic parameters including visual acuity and retinal structure evaluated with optical coherent tomography (OCT) in cases with neuromyelitis optica spectrum disorder (NMOSD) who relapsed with ON despite maintenance therapy with oral PSL
We evaluated the following items before and after immunosuppressive therapy: the extended ARR based on the relapse number of ON, the presence of myelitis and encephalitis, the dosage of PSL, complications of immunosuppressants, best-corrected visual acuity (BCVA) converted into the logarithm of the minimum angle of resolution, and circumpapillary retinal nerve fiber layer, and ganglion cell layer + inner plexiform layer (GCL+) thickness obtained by optical coherence tomography (OCT)
Summary
Sotaro Mori ,1 Takuji Kurimoto ,1 Yusuke Murai, Kaori Ueda, Mari Sakamoto, Norio Chihara, Yuko Yamada-Nakanishi, and Makoto Nakamura. Oral prednisolone is the first-line treatment for preventing recurrent optic neuritis (ON) after the completion of acute-phase treatment, especially anti-aquaporin 4 (AQP4) antibody-positive ON, and anti-myelin oligodendrocyte glycoprotein (MOG) antibody-positive ON, some patients experience relapses. Immunosuppressants could be effective in reducing the recurrence rate for neuromyelitis optica spectrum disorder and MOG antibody-related diseases, but there have been few studies addressing this issue focusing on the changes in ophthalmic parameters. E median ON ARR before immunosuppressive therapy was 0.33, and this decreased significantly to 0 after the therapy (p 0.02). E dose of prednisolone was reduced from 17.8 ± 7.1 mg/day before to 5.8 ± 2.2 mg/day after immunosuppressive therapy (p < 0.01). Immunosuppressants can potentially decrease relapses and steroid dosage in patients with anti-AQP4 or MOG antibody-positive ON without severe adverse events and the exacerbation of visual acuities
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