Abstract

Volume.127 Number.12

Original article : Clinical science

Efficacy of Maintenance Steroid Monotherapy in Anti-myelin Oligodendrocyte Glycoprotein Antibody-positive Optic Neuritis
Yasuyuki Takai1, Akiko Yamagami1, Mayumi Iwasa1, Kenzi Inoue1, Masato Wakakura1, Toshiyuki Takahashi2,3, Keiko Tanaka4,5
1 Inouye Eye Hospital
2 Department of Neurology, Tohoku University Graduate School of Medicine
3 Department of Neurology, National Hospital Organization Yonezawa National Hospital
4 Department of Animal Model Development, Biosource Science Branch, Center for Biosource-based Researches, Brain Research Institute, Niigata University
5 Department Multiple Sclerosis & Therapeutics, Fukushima Medical University School of Medicine

Objective: Anti-myelin oligodendrocyte glycoprotein antibody-positive optic neuritis (MOGON) is prone to relapse; however, strategies for relapse prevention are currently unclear. This study aimed to evaluate the efficacy of oral prednisolone (PSL) maintenance therapy and PSL tapering regimens in patients with MOGON.
Subjects and methods: The efficacy of oral PSL maintenance therapy was retrospectively evaluated using medical records of 25 MOGON patients. Recurrence rates were compared by categorizing them into two groups: those who continued maintenance therapy for at least 6 months after initial onset (maintenance therapy group) and those who completed the therapy within 6 months (no maintenance therapy group). To evaluate PSL tapering regimens, we evaluated 38 optic neuritis attacks (including both initial and recurrent attacks) within 5 years after the initial attack. Rate of recurrence was compared by categorizing the patients into two groups: those who received tapered PSL of 10 mg or more at 2 months and 5 mg or more at 6 months and 1 mg or more at 8 months (slow tapering group) and those who did not taken PSL or received tapered PSL of less than 10 mg at 2 months and/or less than 5 mg at 6 months and/or less than 1 mg at 8 months (rapid tapering group).
Results: The mean age of the patients at the initial attack was 46 years (range: 20-72 years; 11 men and 14 women) and the mean follow-up period was 62 months (range: 6-140 months). The annual relapse rate was significantly lower in the maintenance therapy group (14 cases) than in the no maintenance therapy group (11 cases) [no maintenance vs. maintenance; 0 (0-0.049) vs. 0 (0-0.032), p< 0.05]. Regarding the review of PSL tapering regimens, the slow-tapering group (16 attacks) had a lower recurrence rate than the rapid-tapering group (22 attacks) (25.0% vs. 63.6%; odds ratio 0.20: 95% confidence interval 0.03-0.94, p< 0.05).
Conclusions: In MOGON, adequate maintenance therapy after the first attack can reduce relapses. In particular, postictal slow PSL tapering can be effective for preventing relapses.
Nippon Ganka Gakkai Zasshi (J Jpn Ophthalmol Soc) 127: 1103-1109,2023.

Key words
Optic neuritis, Anti-myelin oligodendrocyte glycoprotein (MOG) antibody, Steroid
Reprint requests to
Yasuyuki Takai, M. D.　Inouye Eye Hospital. 4-3 Kanda-Surugadai, Chiyoda-ku, Tokyo 101-0062, Japan
Received: 23 February 2023. Accepted in revised form: 30 June 2023.
Nihon Ganka Gakkai Zasshi 127: 1103-1109,2023