Intravenous immunoglobulin for the acute treatment of refractory optic neuritis in Japan

To investigate the usage status and evaluate the efficacy of intravenous immunoglobulin (IVIG) for the acute treatment of optic neuritis (ON) in Japan.

Multicenter retrospective case series.

The study subjects were patients with steroid-resistant acute ON in whom IVIG had been initiated between January 2020 and August 2022 at 30 facilities in Japan. The clinical characteristics, visual acuity, and adverse events following IVIG were compared among anti-aquaporin 4 antibody positive ON (AQP4-ON), anti-myelin oligodendrocyte glycoprotein antibody positive ON (MOG-ON), and idiopathic ON (ION).

The study included sixty-five patients (76 eyes); the main clinical department administering IVIG was ophthalmology (50 cases, 77.0 %). 43 cases had their first ON attack and 22 cases had recurrent ON. Plasmapheresis (PP) was combined in 21 cases. The efficacy endpoint, changes in logarithm of the minimum angle of resolution (logMAR) after IVIG compared with preIVIG, showed statistically significant improvement in the AQP4-ON group at one week, 4 weeks, and 12 weeks after IVIG (p=0.015, p<0.001, p<0.001, respectively). In the MOG-ON group, excluding cases with combined PP, logMAR post IVIG did not improve significantly compared with preIVIG. Among the ION group, compared with preIVIG, logMAR at 4weeks and 12 weeks post IVIG were statistically significant improved (p=0.019, p=0.023, respectively). Adverse events occurred in 7 patients with IVIG. 4 of the 7 patients continued the IVIG treatment, and 3 patients discontinued it within 5 days.

This study demonstrates that IVIG may be an effective new option for acute treatment of steroid-resistant ON as an add-on to conventional therapy.