Zhao Juan, Meng Chao, Jiang Hanqiu, Lai Chuntao, Guo Yanjun, Zhu Liping, Wang Jiawei
Department of Neurology, Beijing Tongren Hospital, Capital Medical University, Beijing, 100176, China.
Heliyon. 2024 Jun 18;10(12):e33263. doi: 10.1016/j.heliyon.2024.e33263. eCollection 2024 Jun 30.
There is no consensus on the timing of immunotherapeutic strategies for the first-episode anti-myelin oligodendrocyte glycoprotein-IgG (MOG-IgG) associated disorders (MOGAD) presenting with isolated optic neuritis (ON).
To investigate the optimal timing of intravenous methylprednisolone therapy (IVMP) and necessity of immunosuppressive therapy for the first-episode isolated MOG-IgG associated ON (iMOG-ON).
Adult patients with the first-episode iMOG-ON were enrolled. Primary outcomes were best-corrected visual acuity (BCVA) at last follow-up (i.e. final BCVA) and relapse, and their predictors were assessed by multivariate analysis.
62 patients were included. Logistic regression analysis revealed BCVA at the time of IVMP (odds ratio: 0.463 (95 % confidence interval (CI) 0.310-0.714) was a factor predictive of regaining a final BCVA of 0.0 logMAR vision, and its Youden optimal criterion was <0.175 logMAR by plotting the receiver operating characteristic curve. The time-dependent cox proportional hazards model exhibited MMF therapy was not associated with a high likelihood of relapse-free survival (HR = 1.099, 95 % CI 0.892-1.354, P = 0.376) after adjusting for age of onset, gender, and baseline MOG serum titers. Similar analysis exhibited evidently negative association between high MOG-IgG serum titers at baseline and relapse-free survival after adjusting for age of onset, gender, and MMF therapy (HR = 0.339, 95 % CI 0.155-0.741, P = 0.007).
During the first episode of iMOG-ON, the optimal timing of IVMP may be a short timeframe before visual acuity decreasing to 0.175 logMAR, and MMF therapy may not be recommended for patients with low MOG-IgG serum titers. Further long-term follow-up studies are required to validate these findings.
对于首次发作的伴有孤立性视神经炎（ON）的抗髓鞘少突胶质细胞糖蛋白-IgG（MOG-IgG）相关疾病（MOGAD），免疫治疗策略的时机尚无共识。
探讨静脉注射甲泼尼龙治疗（IVMP）首次发作的孤立性MOG-IgG相关视神经炎（iMOG-ON）的最佳时机以及免疫抑制治疗的必要性。
纳入首次发作iMOG-ON的成年患者。主要结局为末次随访时的最佳矫正视力（BCVA，即最终BCVA）和复发情况，并通过多因素分析评估其预测因素。
共纳入62例患者。逻辑回归分析显示，IVMP时的BCVA（比值比：0.463（95%置信区间（CI）0.310 - 0.714））是预测最终BCVA恢复至0.0 logMAR视力的一个因素，通过绘制受试者工作特征曲线，其约登最佳标准为<0.175 logMAR。时间依赖性Cox比例风险模型显示，在调整发病年龄、性别和基线MOG血清滴度后，霉酚酸酯治疗与无复发生存的高可能性无关（风险比 = 1.099，95% CI 0.892 - 1.354，P = 0.376）。类似分析显示，在调整发病年龄、性别和霉酚酸酯治疗后，基线时高MOG-IgG血清滴度与无复发生存之间存在明显的负相关（风险比 = 0.339，95% CI 0.155 - 0.741，P = 0.007）。
在iMOG-ON首次发作期间，IVMP的最佳时机可能是视力下降至0.175 logMAR之前的短时间内，对于MOG-IgG血清滴度低的患者可能不建议使用霉酚酸酯治疗。需要进一步的长期随访研究来验证这些发现。
