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  • Does time equal vision in AQP4-IgG positive NMOSD optic neuritis?

    Neuro-Ophthalmology/Orbit

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    Review of: Rapid administration of high-dose intravenous methylprednisolone improves visual outcomes after optic neuritis in patients with AQP4-IgG-positive NMOSD

    Akaishi T, Takeshita T, Himori N, et al. Frontiers in Neurology, September 2020

    This study evaluates the impact of rapid high-dose intravenous methylprednisolone pulse therapy in patients with serum anti-aquaporin-4 immunoglobulin G (AQP4-IgG)–positive neuromyelitis optica spectrum disorders (NMOSDs) who had an attack of optic neuritis (ON).

    Study design

    The investigators retrospectively reviewed 36 optic neuritis (ON) attacks from 32 consecutive AQP4-IgG–positive NMOSD patients and evaluated for factors that influenced the visual outcomes.  

    Outcomes

    Earlier treatment of AQP4-IgG–positive ON with IV methylprednisolone pulse therapy was associated with a better visual prognosis 1 year after the attack (Spearman’s rho=0.50, P=0.0018). In addition, the length of the ON lesion on MRI was associated with the visual outcome (Spearman’s rho=0.669, P<0.001) and younger age was associated with better outcomes on multivariate analysis. The observed impact of early IV steroids was independent of the length of the ON lesion on MRI.

    Limitations

    The main limitation of this study is the relatively small sample size and the retrospective nature of the analysis. In addition, over half of patients were treated with plasma exchange, which complicates the interpretation of the findings.

    Clinical significance

    This study suggests that rapid initiation of IV methylprednisolone may lead to better visual outcomes in ON from AQP4-IgG–positive NMOSD. Because AQP4-IgG testing results often take 1 to 2 weeks to return, the authors recommend early IV methylprednisolone for any acute ON that is suggestive of AQP4-IgG ON, even before confirmation of AQP4-IgG positivity. Future randomized clinical trials are required to confirm these findings.