Optic neuritis (ON) is most often associated with multiple sclerosis (MS), but it can also be a symptom of other autoimmune disorders, including neuromyelitis optica spectrum disorder (NMOSD) and myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD).
“Early diagnosis of NMOSD and MOGAD is crucial, as it impacts the course of treatment, clinical outcomes, and morbidity,” said Negar Moheb, MD, at the Mayo Clinic in Rochester, Minnesota.
Fortunately, scientific knowledge of NMOSD and MOGAD continues to expand. “Our understanding of NMOSD has been growing since the discovery of the aquaporin-4 [AQP4] antibody in 2004, which was found to be both a biomarker and pathologic cause of the disease,” said John J. Chen, MD, PhD, also at the Mayo Clinic. More recently, he said, MOG antibodies were found to be a biomarker of MOGAD.
MOGAD-ON. Magnetic resonance imaging shows prominent longitudinal enhancement of the right optic nerve in a patient with MOGAD-ON.
Key points in diagnosis and treatment. In a comprehensive review of current diagnostic and treatment options for these atypical forms of ON,1 Drs. Chen and Moheb highlighted the following key points for clinicians:
- NMOSD-ON is associated with poor visual outcomes. Therefore, early treatment with high-dose corticosteroids and plasma exchange are recommended for acute attacks. All patients with NMOSD-ON require long-term treatment with an immunotherapeutic agent, such as rituximab or one of the recent FDA-approved monoclonal antibody treatments.
- MOGAD-ON is usually responsive to high-dose corticosteroids and has a generally favorable visual outcome. However, some cases are corticosteroid dependent or have a relapsing disease course and require long-term maintenance therapy; options include IV immunoglobulin or tocilizumab.
- Because treatments for NMOSD-ON and MOGAD-ON are different from those for MS and other forms of ON, AQP4 and MOG antibodies
should be checked in any patient with ON unless he or she has classic features of MS (both clinically and radiologically). For instance, Drs. Chen and Moheb wrote, the periventricular white-matter lesions typically seen in MS are rare in NMOSD-ON.
On the research front. Strategies to diagnose and treat NMOSD-ON and MOGAD-ON are actively evolving, as multiple clinical studies are in progress or have recently concluded, Dr. Chen noted. For instance, he said, the FDA approved eculizumab, inebilizumab, and satralizumab for the treatment of NMOSD, based on results of three trials that reached completion in 2019. And two clinical trials are now enrolling patients with MOGAD to investigate rozanolixizumab and satralizumab, Dr. Moheb said.
—Patricia Weiser, PharmD
1 Moheb N, Chen JJ. Eye (Lond). Published online March 16, 2023.
Relevant financial disclosures: Dr. Chen—Horizon: C; UCB: C. Dr. Moheb—None.
For full disclosures and the disclosure key, see below.
Full Financial Disclosures
Dr. Chen Horizon: C; UCB: C.
Dr. Curcio Apellis: C; Astellas: C; Boehringer Ingelheim: C; Character Biosciences: C; Genentech/Hoffman LaRoche: C; Heidelberg Engineering: S; NIH: S; Osanni: C; Regeneron: S.
Dr. Moheb None.
Dr. Owsley Co-inventor of AdaptDx device; Johnson & Johnson Vision: C; NIH: S.
Dr. Shahon None.
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