Contributions
Abstract: EP1409
Type: ePoster
Abstract Category: Clinical aspects of MS - Neuro-ophthalmology
Background: Many demyelinating disorders (DD), including multiple sclerosis(MS), optic neuritis (ON), transverse myelitis, and Guillain-Barré syndrome, have been reported associated with tumor necrosis factor alpha antagonist therapy (TNFαA). ON is the most commonly reported DD (80% of cases). Many ON case studies report poorer recovery with TNFαA (56%) compared to the ON Treatment Trial (90%).
Methods: An observation case report, as well as a comprehensive literature review of ON in association with TNFαA was performed. Type of ON, treatment used, and patient recovery, were the main focuses of the review.
Results: 42-year-old female with a 5 month history of panuveitis was started on adalimumab for further management. After 3 months of adalimumab she developed pain and blurry vision in right eye. Funduscopy revealed right optic disc edema. MRI brain found right optic nerve enhancement and punctate nonspecific T2 hyperintensities. MRI C and T spine showed no abnormalities. Adalimumab was suspected as the cause and discontinued. She was treated with 5 days IV methylprednisolone, and had no improvement in vision with persistent right disc edema ten days after steroid completion. She then received five treatments of plasma exchange. Disc edema resolved. 5months later, vision had improved to 20/250 from hand motion only.
Literature search revealed 55 cases of ON in association with TNFαA; 30 (54%) had complete recovery, 10 (18%) had no improvement, and 15 (27%) had partial improvement. Of those with no recovery, all received IV steroids. One started interferon β for concerns of MS. Of those with partial recovery, 8 received IV steroids (1 also received plasma exchange, and 1 also received rituximab), 2 were treated with oral steroids, 1 was treated with IVIG, and 4 received no treatment. Of those with complete recovery 22 received IV steroids, 3 oral steroids, 1 interferon β, and 4 received no treatment. Anterior ON was present in 18 (32%) cases; 6 had no improvement, 5 had partial improvement, and 7 had complete recovery.
MS was suspected in 6 cases on presentation or follow-up from all groups. Severity of ON and recovery were not predictors of those who went on to have a diagnosis of MS.
Conclusion: ON in association with TNFαA remains uncommon. However, outcomes are less favorable than those reported with idiopathic ON. Optic disc edema in association with ON was associated with poor recovery. In these patients plasma exchange should be considered.
Disclosure: Scott Belliston, DO: has fellowship grants from the National MS Society
Thomas Whittaker, MD: has nothing to disclose
Sharon Lynch, MD: has received grant/research support from Actelion, Bayer, Biogen Idec, Cephalon, Eli Lilly, EMD Serono, Genzyme, Novartis, Ono Pharma, Pfizer, Receptos, Genentech, Roche, Sanofi Aventis, Sun Pharma and Teva Neuroscience.
Abstract: EP1409
Type: ePoster
Abstract Category: Clinical aspects of MS - Neuro-ophthalmology
Background: Many demyelinating disorders (DD), including multiple sclerosis(MS), optic neuritis (ON), transverse myelitis, and Guillain-Barré syndrome, have been reported associated with tumor necrosis factor alpha antagonist therapy (TNFαA). ON is the most commonly reported DD (80% of cases). Many ON case studies report poorer recovery with TNFαA (56%) compared to the ON Treatment Trial (90%).
Methods: An observation case report, as well as a comprehensive literature review of ON in association with TNFαA was performed. Type of ON, treatment used, and patient recovery, were the main focuses of the review.
Results: 42-year-old female with a 5 month history of panuveitis was started on adalimumab for further management. After 3 months of adalimumab she developed pain and blurry vision in right eye. Funduscopy revealed right optic disc edema. MRI brain found right optic nerve enhancement and punctate nonspecific T2 hyperintensities. MRI C and T spine showed no abnormalities. Adalimumab was suspected as the cause and discontinued. She was treated with 5 days IV methylprednisolone, and had no improvement in vision with persistent right disc edema ten days after steroid completion. She then received five treatments of plasma exchange. Disc edema resolved. 5months later, vision had improved to 20/250 from hand motion only.
Literature search revealed 55 cases of ON in association with TNFαA; 30 (54%) had complete recovery, 10 (18%) had no improvement, and 15 (27%) had partial improvement. Of those with no recovery, all received IV steroids. One started interferon β for concerns of MS. Of those with partial recovery, 8 received IV steroids (1 also received plasma exchange, and 1 also received rituximab), 2 were treated with oral steroids, 1 was treated with IVIG, and 4 received no treatment. Of those with complete recovery 22 received IV steroids, 3 oral steroids, 1 interferon β, and 4 received no treatment. Anterior ON was present in 18 (32%) cases; 6 had no improvement, 5 had partial improvement, and 7 had complete recovery.
MS was suspected in 6 cases on presentation or follow-up from all groups. Severity of ON and recovery were not predictors of those who went on to have a diagnosis of MS.
Conclusion: ON in association with TNFαA remains uncommon. However, outcomes are less favorable than those reported with idiopathic ON. Optic disc edema in association with ON was associated with poor recovery. In these patients plasma exchange should be considered.
Disclosure: Scott Belliston, DO: has fellowship grants from the National MS Society
Thomas Whittaker, MD: has nothing to disclose
Sharon Lynch, MD: has received grant/research support from Actelion, Bayer, Biogen Idec, Cephalon, Eli Lilly, EMD Serono, Genzyme, Novartis, Ono Pharma, Pfizer, Receptos, Genentech, Roche, Sanofi Aventis, Sun Pharma and Teva Neuroscience.