Addition of IVIG May Be Superior to Addition of Plasmapheresis in Corticosteroid-Resistant Optic Neuritis: Systemic Review

While the efficacy of corticosteroids (CS) is well-established as first-line treatment of optic neuritis (ON) in demyelinating disease, there is no consensus on second-line treatment. A team of French investigators conducted a meta-analysis and systematic review to compare the efficacy of CS alone against CS combined with intravenous immune globulin (IVIG) or CS combined with plasmapheresis (PP) in patients with steroid-resistant ON.

A total of six comparative studies, representing 209 patients, were identified from a systematic review of all studies published on PubMed between January 2000 and June 2022 that compared at least two of the three treatment options for steroid-resistant ON. Respective rates of significant visual recovery following acute treatment of ON with CS alone, CS plus PP and CS plus IVIG were 30 percent, 45 percent and 77 percent, yielding respective odds ratios of 12.81, 2.47 and 0.19.

The investigators concluded that treatment of steroid-resistant ON with CS plus IVIG or CS with PP is more effective than treatment with CS alone. And, while no study has directly compared the two treatments, IVIG may be more effective than PP in this clinical setting.     ❖