Efficacy of Plasma Exchange Treatment for Demyelinating Optic Neuritis Associated with Various Serum Antibodies: A Prospective Cohort Study

• Published in: Neurology and therapy Vol. 11; no. 2; pp. 797 - 813
• Main Authors: Fu, Junxia, Wang, Yongping, Li, Hongen, Zhou, Huanfen, Song, Honglu, Sun, Mingming, Xu, Quangang, Tan, Shaoying, Wei, Shihui
• Format: Journal Article
• Language: English
• Published: Cheshire Springer Healthcare 01.06.2022
• Subjects: Internal Medicine; Medicine; Medicine & Public Health; Neurology; Original Research; Efficacy; Plasma Exchange; Antibody; Acute Optic Neuritis
• ISSN: 2193-8253; 2193-6536
• DOI: 10.1007/s40120-022-00344-w

Introduction To evaluate the value of plasma exchange (PE) for patients with three subtypes of demyelinating optic neuritis (ON): aquaporin-4 (AQP4) antibody-positive ON (AQP4-ON), myelin oligodendrocyte glycoprotein (MOG) antibody-positive ON (MOG-ON), and AQP4 and MOG double-antibody-seronegative ON (D-ON). Methods A single-center prospective study compared the logarithm of the minimum angle of resolution (logMAR) best-corrected visual acuity (BCVA) at most severe onset, 1 day before intravenous high-dose methylprednisolone (IVMP) treatment, 1 day before PE treatment, after five-cycles of PE therapy, and at 1-, 3-, and 6-month follow-up visits. The proportions of eyes in each visual outcome category were also compared. Logistic regression and a receiver operating characteristic curve were used to analyze predicted factors for VA improvement. Results A total of 124 ON attacks of 122 patients were included. No significant differences were found in BCVA ( P  = 0.659) before and after PE therapy for 22 D-ON attacks, but VA improved in two of six MOG-ON patients. In 95 AQP4-ON patients suffering 96 attacks, the mean logMAR BCVA markedly improved and was steadily maintained after five-cycles of PE treatments (adjusted P  < 0.001), with VA exhibiting a significantly increasing trend (adjusted P  = 0.001) after PE treatment. The combination of the number of previous ON episodes and the time window to PE treatment showed accuracy of 74.7% for predicting an improvement in BCVA score ≥ 2 levels. In addition, a combination of logMAR VA before PE and the time window to PE treatment resulted in 83.4% accuracy in predicting whether VA would regain 1.0 logMAR. Conclusion PE therapy effectively improves visual outcomes for AQP4-ON patients, but offers limited value for D-ON patients. Early initiation greatly increases likelihood of achieving VA improvement.