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Efficacy and comparison of corticosteroids only and corticosteroids with plasmapheresis or intravenous immunoglobulin for the treatment of optic neuritis in demyelinating disease: A systematic review and network meta-analysis.
Gaulier, Arnaud; Hardouin, Jean-Benoit; Wiertlewski, Sandrine; Lebranchu, Pierre.
Affiliation
  • Gaulier A; Department of Ophthalmology, University Hospital of Nantes, Nantes, France. Electronic address: arnaudgaulier@hotmail.fr.
  • Hardouin JB; PhD-HDR, University Hospital of Nantes, UMR INSERM U1246-SPHERE, Institut de Recherche en Santé 2, France.
  • Wiertlewski S; Department of Neurology, University Hospital of Nantes, Nantes, France.
  • Lebranchu P; Department of Ophthalmology, University Hospital of Nantes, Nantes, France; École Centrale Nantes, LS2N, UMR6004, F-44000 Nantes, France.
Mult Scler Relat Disord ; 85: 105521, 2024 May.
Article in En | MEDLINE | ID: mdl-38457882
ABSTRACT

PURPOSE:

To compare the efficacy of treatment of optic neuritis (ON) with corticosteroids (CTC) alone, CTC+plasmapheresis (PLP), and CTC+intravenous immunoglobulin (IVIG).

DESIGN:

After an episode of ON, although visual recovery is usually good, some patients may have significant visual sequelae. While the efficacy of first-line CTC is now indisputable, there is no consensus on the nature of second-line treatment. To date, no systematic review has compared the efficacy of treatment of ON with CTC alone, CTC+plasmapheresis (PLP), and CTC+intravenous immunoglobulin (IVIG). A meta-analysis is needed to compare the efficacy of PLP and IVIG in steroid-resistant ON.

METHODS:

This systematic review included all studies comparing at least two of the three treatments for steroid-resistant ON (CTC alone, CTC+PLP, and CTC+IVIG). From all articles published on PubMed between January 2000 and June 2022, two independent ophthalmologists selected studies of interest using the PRISMA method. Methodology, patient characteristics, and outcomes were identified. A network metaanalysis was then performed to compare the efficacy of the three treatments.

RESULTS:

Six comparative studies were included, representing 209 patients. The percentage of significant visual recovery after CTC alone, CTC+PLP, and CTC+IVIG in the acute treatment of steroid-resistant ON was 30 %, 45 %, and 77 %, respectively. Comparison of CTC+IVIG vs CTC alone, CTC+PLP vs CTC only, and CTC+PLP vs CTC+IVIG yielded odds ratios of 12.81, 2.47, and 0.19 respectively.

CONCLUSION:

Treatment of steroid-resistant ON with CTC+PLP or CTC+IVIG is more effective than treatment with CTC alone. Although no study has directly compared the two treatments, IVIG may be more effective than PLP.
Subject(s)
Key words

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Optic Neuritis / Plasmapheresis / Immunoglobulins, Intravenous / Adrenal Cortex Hormones / Network Meta-Analysis Limits: Humans Language: En Journal: Mult Scler Relat Disord Year: 2024 Document type: Article Country of publication:

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Optic Neuritis / Plasmapheresis / Immunoglobulins, Intravenous / Adrenal Cortex Hormones / Network Meta-Analysis Limits: Humans Language: En Journal: Mult Scler Relat Disord Year: 2024 Document type: Article Country of publication: