Background Non ischaemic optic neuritis (NION) is a severe inflammation of the optic nerve that may lead to blindness. It can be primary or associated to immune mediated inflammatory diseases (IMIDs). The treatment of the NION is based on systemic corticosteroids and conventional immunosuppressive drugs.
Objectives To assess the efficacy of the biological treatment in refractory NION to conventional treatment.
Methods Multicenter study of 12 patients diagnosed with NION refractory to systemic corticosteroids and at least one conventional immunosuppressive drug. The main outcomes were visual acuity (VA) and optical coherence tomography (OCT) of the optic nerve and the ganglionar cells. Comparisons were made between baseline and the 1st week, 1st and 6th month and 1st year. (STATISTICA, StatSoft Inc. Tulsa, Oklahoma, USA).
Results We studied 12 patients (19 affected eyes) (5 men/7 women); mean age of 29.8 ±12.9 years. The underlying diseases were systemic lupus erythematosus (n=1), neuromyelitis optica (n=1), neuroretinitis (n=1), relapsing polychondritis (n=1), pars planitis (n=1), Behçet’s disease (n=2) and idiopathic (n=5). Before biological treatment and besides oral corticosteroids, patients had received intravenous (IV) methylprednisolone boluses (n=9), cyclosporine A (n=1), cyclophosphamide (n=2), mycophenolate (n=2), hydroxychloroquine (n=1), methotrexate (n=8) and azathioprine (n=5). Biological treatment was bases on rituximab (n=2) (2 IV, doses of 1 g/every 2 weeks and every 6 moths), adalimumab (n=5) (40 mg/1-2 week), tocilizumab (n=4) (8 mg/kg/2-4 weeks) and infliximab (n=3) (5 mg/kg at 0, 2 and 6 week and then every 8 weeks). The characteristics of the 12 patients are shown in the TABLE.
After biological treatment we observed an improvement in the ocular parameters: VA [0.66±0.32 to 0.84±0.29; p= 0.03], OCT of the optic nerve [123.20±58.28 to 190.54±175.38; p= 0.11], and OCT of the ganglionar cells [369.55±137.37 to 270.67±23.21; p= 0.03] at one year. After a mean follow-up of 29.09 ±19.23 months, there were no severe adverse effects.
Conclusion Biologic therapy in NION idiopathic or associated to IMIDs, refractory to conventional treatment, seems to be effective.
Disclosure of Interests D. Prieto-Peña: None declared, Monica Calderón-Goercke: None declared, Vanesa Calvo-Río: None declared, Olga Maiz-Alonso Speakers bureau: Pfizer, Ana Blanco: None declared, J. Narváez Consultant for: Bristol-Myers Squibb, Santos Castañeda Consultant for: Amgen, BMS, Pfizer, Lilly, MSD, Roche, Sanofi, UCB, Esther Vicente: None declared, Susana Romero-Yuste: None declared, Rosalía Demetrio-Pablo: None declared, ANA URRUTICOECHEA-ARANA: None declared, José L. García-Serrano: None declared, Jose Luis Callejas-Rubio: None declared, Norberto Ortego: None declared, Julio Sánchez: None declared, Miguel A González-Gay Grant/research support from: Prof. MA Gonzalez-Gay received grants/research supports from Abbvie, MSD, Jansen and Roche., Speakers bureau: Consultation fees/participation in company sponsored speaker’s bureau from Pfizer, Lilly, Sobi, Celgene, Novartis, Roche and Sanofi., Ricardo Blanco Grant/research support from: Abbvie, MSD, and Roche, Consultant for: Abbvie, Pfizer, Roche, Bristol-Myers, Janssen, Speakers bureau: Abbvie, Pfizer, Roche, Bristol-Myers, Janssen
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