Early high-dose intravenous methylprednisolone is effective in preserving retinal nerve fiber layer thickness in patients with neuromyelitis optica

Nakamura, Masahiko; Nakazawa, Toru; Doi, Hiroshi; Hariya, Takehiro; Omodaka, Kazuko; Misu, Tatsuro; Takahashi, Toshiyuki; Fujihara, Kazuo; Nishida, Kohji

doi:10.1007/s00417-010-1344-7

Cited by 121 publications

(113 citation statements)

References 38 publications

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“…It would seem logical that the earlier the steroid treatment is initiated, the better the chances of a beneficial effect, but other studies showing this (Nakamura et al., 2010; Plant et al., 2011) may have been hampered by underpowering, heterogeneity of the background diagnoses of the patients and inconsistencies in follow‐up.…”

Section: Discussionmentioning

confidence: 99%

“…The relevant hospital departments and private ophthalmologists were continuously reminded to refer patients to study participation as quickly as possible to minimize the delay before any steroid treatment was initiated. It could be argued that early onset treatment should have been initiated even earlier, preferably within 3 days (Nakamura et al., 2010). However, in a clinical setting this is very difficult to achieve.…”

Section: Discussionmentioning

confidence: 99%

“…However, the time of initiation of treatment after symptom presentation may be important for the effect, for instance, the earlier the treatment is initiated there may be a chance for protecting visual function and retinal cell layers (Nakamura et al., 2010; Plant, Sibtain, & Thomas, 2011). …”

Section: Introductionmentioning

confidence: 99%

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Time to steroid treatment in severe acute optic neuritis

et al. 2018

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ObjectivesSteroid treatment can accelerate visual recovery in patients with optic neuritis (ON), but it is unknown whether the timing of the start of treatment influences the outcome. The main purpose of this observational study was to assess the effect of early onset steroid treatment of ON on visual prognosis and retinal morphology.MethodsForty‐nine patients with acute mild/moderate (n = 21) or severe (n = 28) ON, and an equal number of healthy controls were enrolled. Patients with severe ON either received early onset steroid treatment (initiated within 1 week of presentation with visual loss) (n = 9), late‐onset treatment (initiated after 1 week) (n = 13), or no treatment (n = 6). Visual function and retinal morphology was studied after 6 and 12 months.ResultsAll measures of visual function had improved after 6 months (p ≤ 0.03) in the three groups with severe ON. This was not the case for Rayleigh match setting range (SR) in the nontreated group (p = 0.24), or for SR (p = 0.08) and latency to P100 of visual evoked potential (p = 0.08) in the late‐onset treated group. After 12 months, further improvement occurred in the nontreated and late‐treated groups, but not in the early treated group. Macular retinal nerve fiber layer (mRNFL) and ganglion cell plus inner plexiform layer had decreased significantly (p ≤ 0.001) in all three groups with severe ON after 6 months. After 12 months, only mRNFL had further significantly decreased and only in the late‐onset treated group (p = 0.02).ConclusionThe beneficial effects of early onset steroid treatment of ON is limited to a few months whereas the long‐term prognosis is independent of the timing of treatment.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Time to steroid treatment in severe acute optic neuritis

et al. 2018

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“…It has been shown that each, a first, second, and third course of IVMP significantly improves clinical disability in patients with MS and NMOSD [34], and that early administration is associated with preservation of the retinal nerve fiber layer thickness in NMOSD [35].…”

Section: Treatment Of Nmosd Attacksmentioning

confidence: 99%

Present and Future Therapies in Neuromyelitis Optica Spectrum Disorders

Kleiter

Gold

2016

Neurotherapeutics

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Neuromyelitis optica spectrum disorders (NMOSD) are important evolving entities, which have reached much attention in the recent years. NMOSD are characterized by inflammatory lesions in the optic nerves, spinal cord, and central parts of the brain, as well as an autoimmune process directed against aquaporin-4. As disability in NMOSD accumulates by inflammatory damage from attacks, both the treatment and prevention of attacks are decisive for the long-term outcome. NMOSD attacks are treated with highdose intravenous corticosteroids and apheresis therapies, in particular therapeutic plasma exchange. In cases of incomplete remission, escalation of attack treatment is recommended. Preventive therapy is immunosuppressive and should by commenced as early as possible. Apart from classical immunosuppressants such as azathioprine and mycophenolate mofetil, repurposed biologicals are increasingly used. B-cell depletion with rituximab and other agents, inhibition of the interleukin-6 receptor with tocilizumab, and blockade of complement-mediated damage by eculizumab all are promising therapeutic strategies evaluated in randomized controlled trials. In this review, we will discuss present and future immunotherapies for NMOSD and also consider combination of treatments, plasma, cellular and other therapies. Current advances in immunopathological knowledge are translated into innovative concepts and begin a new era of NMOSD therapy.

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“…The influence of treatment delay upon outcome has been addressed in a single study of first ON receiving steroid treatments (Nakamura et al, 2010). The outcomes were both visual acuity and the width of the retinal fibers layer evaluated with optic tomography (OCT).…”

Section: Evidence Supporting An Early Treatmentmentioning

confidence: 99%