Details and outcomes of a large cohort of MOG-IgG associated optic neuritis

Chen, John J.; Flanagan, Eoin P.; Bhatti, M. Tariq; Tisavipat, Nanthaya; Jamali, Sepideh; Kunchok, Amy; Eggenberger, Eric; Nome, Marie Di; Sotirchos, Elias S.; Vasileiou, Eleni S; Henderson, Amanda D.; Arnold, Anthony C.; Bonelli, Laura; Seleme, Nicolás; Mejia-Vergara, Alvaro J.; Moss, Heather E.; Padungkiatsagul, Tanyatuth; Stiebel‐Kalish, Hadas; Lotan, Itay; Wilf-Yarkoni, Adi; Hellmann, Mark A.; Vuppala, Amrita Amanda D.; Hodge, David O.; Pittock, Sean J.

doi:10.1016/j.msard.2022.104237

Cited by 27 publications

(24 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The progression of vision loss in MOGAD-ON was consistent with our prior report that the median time to nadir was 4 (range 0–30) days. 26 Although acute onset of vision loss is a hallmark of NAION, 25% of our patients had worsening beyond 48 hours, similar to the IONDT's findings. 9 Only one (1.6%) patient with NAION in our cohort had eye pain that increased with eye movement and vision loss worsening beyond 48 hours, suggesting that these combined predictors of MOGAD-ON are specific.…”

Section: Discussionsupporting

confidence: 86%

“…Eye pain in MOGAD-ON is typically moderate-to-severe and precedes the onset of vision loss. 26 Although the 20% eye pain in our NAION cohort was higher than in prior reports, 9 the pain was mild and usually described as pressure type and never as sharp shooting. Of note, eye pain abstracted from clinical documents may be more likely to include mild nonspecific pain from surrounding orbital structures or vague mild ache that some patients report secondary to vision loss, compared with information from clinical trials which use prespecified probing.…”

Section: Discussioncontrasting

confidence: 59%

See 1 more Smart Citation

Acute Optic Neuropathy in Older Adults

Tisavipat,

Stiebel-Kalish,

Palevski

et al. 2024

Neurol Neuroimmunol Neuroinflamm

Self Cite

View full text Add to dashboard Cite

Background and Objectives Myelin oligodendrocyte glycoprotein antibody-associated disease optic neuritis (MOGAD-ON) and nonarteritic anterior ischemic optic neuropathy (NAION) can cause acute optic neuropathy in older adults but have different managements. We aimed to determine differentiating factors between MOGAD-ON and NAION and the frequency of serum MOG-IgG false positivity among patients with NAION. Methods In this international, multicenter, case-control study at tertiary neuro-ophthalmology centers, patients with MOGAD presenting with unilateral optic neuritis as their first attack at age 45 years or older and age-matched and sex-matched patients with NAION were included. Comorbidities, clinical presentations, acute optic disc findings, optical coherence tomography (OCT) findings, and outcomes were compared between MOGAD-ON and NAION. Multivariate analysis was performed to find statistically significant predictors of MOGAD-ON. A separate review of consecutive NAION patients seen at Mayo Clinic, Rochester, from 2018 to 2022, was conducted to estimate the frequency of false-positive MOG-IgG in this population. Results Sixty-four patients with unilateral MOGAD-ON were compared with 64 patients with NAION. Among patients with MOGAD-ON, the median age at onset was 56 (interquartile range [IQR] 50–61) years, 70% were female, and 78% were White. Multivariate analysis showed that eye pain was strongly associated with MOGAD-ON (OR 32.905; 95% CI 2.299–473.181), while crowded optic disc (OR 0.033; 95% CI 0.002–0.492) and altitudinal visual field defect (OR 0.028; 95% CI 0.002–0.521) were strongly associated with NAION. On OCT, peripapillary retinal nerve fiber layer (pRNFL) thickness in unilateral MOGAD-ON was lower than in NAION (median 114 vs 201 μm, p < 0.001; median pRNFL thickening 25 vs 102 μm, p < 0.001). MOGAD-ON had more severe vision loss at nadir (median logMAR 1.0 vs 0.3, p < 0.001), but better recovery (median logMAR 0.1 vs 0.3, p = 0.002). In the cohort of consecutive NAION patients, 66/212 (31%) patients with NAION were tested for MOG-IgG and 8% (95% CI 1%–14%) of those had false-positive serum MOG-IgG at low titers. Discussion Acute unilateral optic neuropathy with optic disc edema in older adults can be caused by either MOGAD-ON or NAION. Detailed history, the degree of pRNFL swelling on OCT, and visual outcomes can help differentiate the entities and prevent indiscriminate serum MOG-IgG testing in all patients with acute optic neuropathy.

show abstract

Section: Discussionsupporting

confidence: 86%

Section: Discussioncontrasting

confidence: 59%

Acute Optic Neuropathy in Older Adults

Tisavipat,

Stiebel-Kalish,

Palevski

et al. 2024

Neurol Neuroimmunol Neuroinflamm

Self Cite

View full text Add to dashboard Cite

show abstract

“…Third, this study lacked a control group that did not receive attack treatment and reports of spontaneous improvement exist. 28,30 However, there are ethical concerns with having a placebo arm for studying acute MOGAD attacks, and the retrospective analysis in this study suggested possible benefits. A future randomized-controlled trial comparing the treatment outcomes in MOGAD patients treated with CS alone versus IVIG (alone or in combination with CS) can better define the place of IVIG as a first-line treatment in acute MOGAD attacks.…”

Section: Discussionmentioning

confidence: 92%

“…7,15,[23][24][25][26] In MOGAD, a similar association has been reported in patients presenting with ON, where early steroid treatment initiation has been associated with better visual outcomes. 23,27,28 Timing of TPE is also correlated with better visual outcomes in MOGAD-ON. 29 While high-dose CS and TPE are reportedly beneficial in other types of MOGAD attacks, 7,15 the impact of the timing of treatment on clinical outcome measures in non-ON-MOGAD attacks is currently unknown.…”

Section: Discussionmentioning

confidence: 92%

Intravenous immunoglobulin treatment for acute attacks in myelin oligodendrocyte glycoprotein antibody disease

et al. 2023

Self Cite

View full text Add to dashboard Cite

Background: The potential therapeutic benefit of intravenous immunoglobulins (IVIGs) for acute attacks of myelin oligodendrocyte glycoprotein antibody disease (MOGAD) is unknown. Objective: The objective was to describe the outcomes of IVIG treatment for acute MOGAD attacks. Methods: A retrospective observational study involving seven tertiary neuroimmunology centers. Data collection included patients’ demographics, Expanded Disability Status Scale (EDSS), and visual acuity (VA) before the attack, at the nadir of the attack before IVIG treatment, and at follow-up visits ⩾3 months after treatment. Results: Thirty-nine patients were included, of which 21 (53.8%) were female. The median age was 23 years (range 5–74 years), and the median disease duration was 4 months (range 0–93 months). The most common type of attack treated with IVIG was isolated optic neuritis (ON) (unilateral n = 14, bilateral n = 5, associated with transverse myelitis (TM), n = 1), followed by acute disseminated encephalomyelitis (ADEM) ( n = 8), multifocal ( n = 7), TM ( n = 3), brainstem ( n = 1), and other encephalitis ( n = 1). A significant improvement in both the EDSS and VA measures was observed at follow-up compared to the time of IVIG treatment initiation ( p < 0.0001 for both outcome measures). Conclusion: IVIG may be an effective treatment option for acute MOGAD attacks. Further prospective studies are warranted to validate our results.

show abstract

“…If neoplasm, haemophagocytic lymphohistiocytosis (HLH), vasculitis or sarcoidosis is suspected based on clinical suspicion and the results of the workup described above, glucocorticoids may confound potential biopsy results, and alternative targeted therapies may be required. 3,[5][6][7][8]11 Recent evidence has suggested that prompt initiation of glucocorticoid treatment may improve paediatric MOGAD outcomes, [20][21][22] although this requires further study. A recent Italian cohort analysis showed a 6.7fold odds reduction in a relapsing course when glucocorticoids were administered less than 7 days from symptom onset.…”

mentioning

confidence: 99%