Treatment of corticosteroid refractory optic neuritis in multiple sclerosis patients with intravenous immunoglobulin

Abstract

The use of IVIG, following corticosteroids, may be useful using the protocol described herein, with sustained pulsed dosing. A larger controlled trial is indicated to confirm these results.

Pediatric optic neuritis

“…42,43 Likewise, case series suggest that plasmapheresis is safe in pediatric demyelination 44 and has potential benefit in steroid-resistant pediatric ON. 45 Although some observational studies suggested a possible benefit to the use of IVIg in corticosteroid-refractory acute ON in adults, 46 a double-blind trial showed no difference between outcomes when comparing IVIg and placebo in acute ON. 47 Evidence for the use of IVIg in pediatric ON is limited to case reports and small case series.…”

Outcomes of toll-like receptors’ antagonism in steroid-resistant optic neuritis; a pilot study

“…The use of high-dose intravenous steroids can result in early recovery, but does not seem to improve long-term visual outcome. There is a small subset of corticosteroid refractory optic neuritis patients [8][9][10][11][12][13]. Currently, there is no established treatment protocol for this group of patients.…”

Treatment of Acute Relapses in Multiple Sclerosis

“…[54] suggest that delayed IV-IG administration had no effect on recovery from optic neuritis. However, an open-label study by Tselis et al [55] showed that some cases of steroid-unresponsive optic neuritis may respond to IV-IG administered 0.4 g/kg/day for 5 days, followed by monthly 0.4 g/ kg infusion for 5 months. Visual acuity response (as defined by a change to 20/30 or better 1 year later) was significantly better in subjects with IV-IG than in those that received only IV-MP.…”

“…Several alternatives, including plasmapheresis [48][49][50][51], cyclophosphamide [48,52,53], intravenous immunoglobulin G (IV-IG) [54][55][56][57][58], and natalizumab [59] have been studied with plasmapheresis as the only option supported by strong clinical evidence. The recent American Academy of Neurology guideline published in January 2011 [60] recommends considering using plasma exchange as a secondary treatment for severe flares in remitting-relapsing MS.…”