AUTHOR=Akaishi Tetsuya , Takeshita Takayuki , Himori Noriko , Takahashi Toshiyuki , Misu Tatsuro , Ogawa Ryo , Kaneko Kimihiko , Fujimori Juichi , Abe Michiaki , Ishii Tadashi , Fujihara Kazuo , Aoki Masashi , Nakazawa Toru , Nakashima Ichiro 

TITLE=Rapid Administration of High-Dose Intravenous Methylprednisolone Improves Visual Outcomes After Optic Neuritis in Patients With AQP4-IgG-Positive NMOSD

JOURNAL=Frontiers in Neurology

VOLUME=11

YEAR=2020

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2020.00932

DOI=10.3389/fneur.2020.00932

ISSN=1664-2295

ABSTRACT=<p><bold>Objective:</bold> The purpose of this study was to elucidate the rapid impact of high-dose intravenous methylprednisolone pulse therapy (1,000 mg/day for 3 days) on the eventual visual prognosis 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).</p><p><bold>Methods:</bold> Data from 32 consecutive NMOSD patients (1 male and 31 female) with at least one ON attack, involving a total of 36 ON-involved eyes, were evaluated. The following variables at ON onset were evaluated: sex, age at the first ON episode, visual acuity at nadir, visual acuity after 1 year, duration from ON onset to treatment for an acute ON attack, cycles of high-dose intravenous methylprednisolone pulse therapy for the ON attack, and cycles of plasmapheresis for the ON attack. Among the 36 ON-involved eyes, 27 eyes were studied using orbital MRI with a short-T1 inversion recovery sequence and gadolinium-enhanced fat-suppressed T1 imaging before starting treatment in the acute phase.</p><p><bold>Results:</bold> In univariate analyses, a shorter duration from ON onset to the initiation of high-dose intravenous methylprednisolone pulse therapy favorably affected the eventual visual prognosis 1 year later (Spearman's rho = 0.50, <italic>p</italic> = 0.0018). The lesion length on orbital MRI was also correlated with the eventual visual prognosis (rho = 0.68, <italic>p</italic> &lt; 0.0001). Meanwhile, the days to steroid pulse therapy and lesion length on orbital MRI did not show a significant correlation. These findings suggest that the rapidness of steroid pulse therapy administration affects the eventual visual prognosis independent of the severity of ON. In multivariate analysis, a shorter time from ON onset to the start of acute treatment (<italic>p</italic> = 0.0004) and a younger age at onset (<italic>p</italic> = 0.0071) were significantly associated with better visual outcomes.</p><p><bold>Conclusions:</bold> Rapid initiation of high-dose intravenous methylprednisolone pulse therapy is essential to preserve the eventual visual acuity in patients with serum AQP4-IgG-positive NMOSD. Once clinicians suspect acute ON with serum AQP4-IgG, swift administration of steroid pulse therapy before confirming the positivity of serum AQP4-IgG would be beneficial for preserving visual function.</p>