Plasma exchange appears effective for neuromyelitis optica-associated acute optic neuritis

This prospective, nonrandomized study found that sequential treatment with pulsed intravenous corticosteroids and plasma exchange is more effective than corticosteroids alone for acute optic neuritis associated with neuromyelitis optica (NMO).

To the authors’ knowledge this is the largest series of optic neuritis associated with NMO treated at the acute phase by plasma exchange. It is also the first study to compare plasma exchange with the conventional treatment of acute optic neuritis by pulsed intravenous corticosteroids.

They assessed the effect of adding plasma exchange to pulsed intravenous corticosteroids in 16 patients with NMO-associated acute optic neuritis and compared the result with 36 patients treated with only corticosteroids.

At least six months after treatment, plasma exchange was effective at improving visual acuity and thickness of nerve fibers of the optic nerve. It was the only independent factor associated with achieving final visual acuity greater than 20/200.

Final visual acuity was 20/400 in the corticosteroid group and 20/50 in the plasma exchange group (P = 0.04). Visual acuity gain was 20/200 in the corticosteroid group and 20/30 in the plasma exchange group (P = 0.01). A poor final visual acuity outcome (≤ 20/200) was found in 53 percent of patients in the corticosteroid group and 13 percent in the plasma exchange group (P = 0.008).

The authors conclude that despite these results, a randomized, multicenter study is needed for definitive validation of plasma exchange for the treatment of NMO optic neuritis.