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Biomarker Defined Acute Optic Neuritis: A Review and Perspective

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Current Treatment Options in Neurology Aims and scope Submit manuscript

Abstract

Purpose of review

This review provides a comprehensive summary of treatment options and management considerations for patients with acute inflammatory optic neuritis. A critical appraisal of the findings from landmark trials to the more recent studies is presented to provide a reference for diagnostic approaches, treatment options, and future research perspectives.

Recent findings

The Optic Neuritis Treatment Trial (ONTT) provides the best natural history study of optic neuritis and its relationship to remitting relapsing multiple sclerosis. In addition, the ONTT produced some unexpected and controversial results about corticosteroid therapy for optic neuritis. More recent studies have added new data about the duration of initial treatment, route of treatment (i.e. intravenous vs. oral bioequivalent), and inclusion of an oral tapering regimen. Although “optic neuritis” was synonymous with relapsing–remitting multiple sclerosis (RRMS) or a “clinically isolated syndrome” during the decade of the ONTT, recent discoveries about the neuromyelitis optica spectrum disorder (NMOSD) and myelin oligodendrocyte glycoprotein antibody-associated disorder (MOGAD) have added biomarker-specific diagnostic diversity to the spectrum of optic neuritis, especially for those events previously labeled as “atypical.” Recognition of the different pathophysiological pathways for the phenotype of optic neuritis has led to new treatment approaches, particularly with plasmapheresis, or PLEX. The TONE, RENEW, ACTION, and ATON trials are also reviewed, which investigated erythropoietin, opicinumab, amiloride, and atacicept, respectively.

Summary

Corticosteroids remain the initial therapy for many cases of acute optic neuritis. With the evolving ease and precision of diagnosing NMOSD and MOGAD by examining peripheral venous blood for autoantibodies, optic neuritis is evolving into a syndrome whose etiology now has the dimension of biomarkers. The discovery of biomarker-defined optic neuritis has enabled the rational treatment options of plasmapheresis, B-cell depletion, complement inhibition, and interleukin-6 therapies.

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  1. Neuro-Ophthalmology Service, Wills Eye Hospital, Thomas Jefferson University Medical College, 840 Walnut Street, Suite 930, Philadelphia, PA, 19107, USA

    Mišo Gostimir MD, MPH & Robert C. Sergott MD

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  1. Mišo Gostimir MD, MPH
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  2. Robert C. Sergott MD
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Correspondence to Robert C. Sergott MD.

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MG has no financial or conflicts of interest to disclose. RCS reports personal fees from Biogen, personal fees from Novartis, personal fees from Horizon Therapeutics, personal fees from Roche, and personal fees from Bristol Myers Squibb outside the submitted work.

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Gostimir, M., Sergott, R.C. Biomarker Defined Acute Optic Neuritis: A Review and Perspective. Curr Treat Options Neurol 25, 307–322 (2023). https://doi.org/10.1007/s11940-023-00762-7

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