Contributions
Abstract: P879
Type: Poster
Abstract Category: Clinical aspects of MS - 5 Epidemiology
Background: Optic neuritis (ON) is associated with multiple sclerosis (MS) and non-MS antibody-mediated causes with specificity for myelin oligodendrocyte glycoprotein (MOG-IgG) or aquaporin-4 (AQP4-IgG).
Objective: The aim was to estimate the incidence of acute ON and the rates of conversion to MS and neuromyelitis optica spectrum disorder (NMOSD).
Method: From 2014-2016, a population-based prospective study with a one-year follow-up was performed in patients with ON, originating from three ophthalmological departments and 44 practicing ophthalmologists in the geographically well-defined Region of Southern Denmark. Patients (>15 years of age) were included with acute or subacute onset of symptoms compatible with ON. Patients with a previous diagnosis of MS or NMOSD were excluded. Diagnostic investigations included ophthalmological and neurological examination and magnetic resonance imaging (MRI). Determination of AQP4-IgG and MOG-IgG were performed, while investigators were masked.
Results: Sixty-three patients were evaluated and 51 fulfilled the criteria for ON. All were Caucasian, with a female:male ratio of 2.2:1 and a median age at onset of 38 years (range 16-66). Forty-four (86%) had a single episode of ON, (bilateral in four), while 7/51 (14%) had recurrent ON. Visual acuity was significantly lower in affected eyes compared to the fellow-eyes at baseline and at follow up, (p=0.001, p=0.01). The overall age-specific incidence was 3.28 (95% confidence interval (CI) 2.44-4.31) per 100.000 person years, 2.02 (95%CI 1.16-3.29) for men and 4.57 (95%CI 3.18-6.36) for women. Twenty patients met the diagnostic criteria for MS, with MRI evidence of lesions disseminated in space and time in 17/20 (85%) patients. None had AQP4-IgG. MOG-IgG was detected in 2/51 (4%) patients, one with recurrent and one with a single episode of ON.
Conclusions: The prospectively determined age-specific incidence of acute isolated ON was 3.28 per 100,000 person years. MRI enabled a diagnosis of MS in a considerable proportion (39%) of patients. Antibody-mediated ON with specificity for MOG was detected in 4% of cases.
Disclosure:
K. Soelberg: Nothing to disclose.
S. Jarius: Nothing to disclose.
HBP. Skejoe: Nothing to disclose
H. Engberg: Nothing to disclose
JJ. Mehlsen: Nothing to disclose
AC. Nilsson: Nothing to disclose
JS. Madsen: Nothing to disclose
M. Reindl: The Neurological Research Laboratory (Medical University of Innsbruck and Tirol Kliniken, Markus Reindl) receives payments for antibody assays (AQP4- and anti-neuronal antibodies) and for AQP4- and MOG-antibody validation experiments organized by Euroimmun (Germany). Markus Reindl was supported by research grant 'BIG WIG MS' from the Austrian Federal Ministry of Science, Research and Economy.
B. Wildemann: The work of B.W. was supported by research grants from the Dietmar-Hopp-Stiftung and from Merck Serono.
J. Grauslund: Nothing to disclose.
KO. Kyvik: Nothing to disclose
TJ. Smith: Terry Smith hold patents on the therapeutic targeting of the insulin-like growth factor I receptor and the clinical assay development of anti-IGF-IR antibodies in autoimmune diseases. I am funded by National Institutes of Health grants EY008976 and 5UM1AI110557, Center for Vision core grant EY007003 from the National Eye Institute, unrestricted grants from Research to Prevent Blindness and the Bell Charitable Foundation
ST. Lillevang: Nothing to disclose
F. Paul: F. Paul serves on the scientific advisory board for Novartis; received speaker honoraria and travel funding from Bayer, Novartis, Biogen Idec, Teva, Sanofi-Aventis/Genzyme, MerckSerono, Alexion, Chugai, MedImmune, and Shire; is an academic editor for PLoS ONE; is an associate editor for Neurology® Neuroimmunology & Neuroinflammation; consulted for SanofiGenzyme, Biogen Idec, MedImmune, Shire, and Alexion; and received research support from Bayer,Novartis, Biogen Idec, Teva, Sanofi-Aventis/Genzyme, Alexion, Merck Serono, German Research Council, Werth Stiftung of the City of Cologne, German Ministry of Education and Research, Arthur Arnstein Stiftung Berlin, EU FP7 Framework Program, Arthur Arnstein FoundationBerlin, Guthy Jackson Charitable Foundation, and National Multiple Sclerosis of the USA.
BG. Weinshenker: Brian Weinshenker receives royalties from RSR Ltd, Oxford University, Hospices Civil de Lyon, and MVZ Labor PD Dr. Volkmann und Kollegen GbR for a patent of NMO-IgG as a diagnostic test for NMO and related disorders. He serves as a member of an adjudication committee for clinical trials in NMO being conducted by MedImmune and Alexion pharmaceutical companies. He is a consultant for Caladrius Biosciences regarding a clinical trial for NMO. He serves as a member of a data safety monitoring committee for clinical trials conducted by Novartis.
N. Asgari: Nothing to disclose.
Study funding: The study was supported by the Region of Southern Denmark, The University of Southern Denmark, the Danish Multiple Sclerosis Society, Lillebaelt Research Foundation, Director Jakob Madsen and Wife Olga Madsen's Foundation.
Abstract: P879
Type: Poster
Abstract Category: Clinical aspects of MS - 5 Epidemiology
Background: Optic neuritis (ON) is associated with multiple sclerosis (MS) and non-MS antibody-mediated causes with specificity for myelin oligodendrocyte glycoprotein (MOG-IgG) or aquaporin-4 (AQP4-IgG).
Objective: The aim was to estimate the incidence of acute ON and the rates of conversion to MS and neuromyelitis optica spectrum disorder (NMOSD).
Method: From 2014-2016, a population-based prospective study with a one-year follow-up was performed in patients with ON, originating from three ophthalmological departments and 44 practicing ophthalmologists in the geographically well-defined Region of Southern Denmark. Patients (>15 years of age) were included with acute or subacute onset of symptoms compatible with ON. Patients with a previous diagnosis of MS or NMOSD were excluded. Diagnostic investigations included ophthalmological and neurological examination and magnetic resonance imaging (MRI). Determination of AQP4-IgG and MOG-IgG were performed, while investigators were masked.
Results: Sixty-three patients were evaluated and 51 fulfilled the criteria for ON. All were Caucasian, with a female:male ratio of 2.2:1 and a median age at onset of 38 years (range 16-66). Forty-four (86%) had a single episode of ON, (bilateral in four), while 7/51 (14%) had recurrent ON. Visual acuity was significantly lower in affected eyes compared to the fellow-eyes at baseline and at follow up, (p=0.001, p=0.01). The overall age-specific incidence was 3.28 (95% confidence interval (CI) 2.44-4.31) per 100.000 person years, 2.02 (95%CI 1.16-3.29) for men and 4.57 (95%CI 3.18-6.36) for women. Twenty patients met the diagnostic criteria for MS, with MRI evidence of lesions disseminated in space and time in 17/20 (85%) patients. None had AQP4-IgG. MOG-IgG was detected in 2/51 (4%) patients, one with recurrent and one with a single episode of ON.
Conclusions: The prospectively determined age-specific incidence of acute isolated ON was 3.28 per 100,000 person years. MRI enabled a diagnosis of MS in a considerable proportion (39%) of patients. Antibody-mediated ON with specificity for MOG was detected in 4% of cases.
Disclosure:
K. Soelberg: Nothing to disclose.
S. Jarius: Nothing to disclose.
HBP. Skejoe: Nothing to disclose
H. Engberg: Nothing to disclose
JJ. Mehlsen: Nothing to disclose
AC. Nilsson: Nothing to disclose
JS. Madsen: Nothing to disclose
M. Reindl: The Neurological Research Laboratory (Medical University of Innsbruck and Tirol Kliniken, Markus Reindl) receives payments for antibody assays (AQP4- and anti-neuronal antibodies) and for AQP4- and MOG-antibody validation experiments organized by Euroimmun (Germany). Markus Reindl was supported by research grant 'BIG WIG MS' from the Austrian Federal Ministry of Science, Research and Economy.
B. Wildemann: The work of B.W. was supported by research grants from the Dietmar-Hopp-Stiftung and from Merck Serono.
J. Grauslund: Nothing to disclose.
KO. Kyvik: Nothing to disclose
TJ. Smith: Terry Smith hold patents on the therapeutic targeting of the insulin-like growth factor I receptor and the clinical assay development of anti-IGF-IR antibodies in autoimmune diseases. I am funded by National Institutes of Health grants EY008976 and 5UM1AI110557, Center for Vision core grant EY007003 from the National Eye Institute, unrestricted grants from Research to Prevent Blindness and the Bell Charitable Foundation
ST. Lillevang: Nothing to disclose
F. Paul: F. Paul serves on the scientific advisory board for Novartis; received speaker honoraria and travel funding from Bayer, Novartis, Biogen Idec, Teva, Sanofi-Aventis/Genzyme, MerckSerono, Alexion, Chugai, MedImmune, and Shire; is an academic editor for PLoS ONE; is an associate editor for Neurology® Neuroimmunology & Neuroinflammation; consulted for SanofiGenzyme, Biogen Idec, MedImmune, Shire, and Alexion; and received research support from Bayer,Novartis, Biogen Idec, Teva, Sanofi-Aventis/Genzyme, Alexion, Merck Serono, German Research Council, Werth Stiftung of the City of Cologne, German Ministry of Education and Research, Arthur Arnstein Stiftung Berlin, EU FP7 Framework Program, Arthur Arnstein FoundationBerlin, Guthy Jackson Charitable Foundation, and National Multiple Sclerosis of the USA.
BG. Weinshenker: Brian Weinshenker receives royalties from RSR Ltd, Oxford University, Hospices Civil de Lyon, and MVZ Labor PD Dr. Volkmann und Kollegen GbR for a patent of NMO-IgG as a diagnostic test for NMO and related disorders. He serves as a member of an adjudication committee for clinical trials in NMO being conducted by MedImmune and Alexion pharmaceutical companies. He is a consultant for Caladrius Biosciences regarding a clinical trial for NMO. He serves as a member of a data safety monitoring committee for clinical trials conducted by Novartis.
N. Asgari: Nothing to disclose.
Study funding: The study was supported by the Region of Southern Denmark, The University of Southern Denmark, the Danish Multiple Sclerosis Society, Lillebaelt Research Foundation, Director Jakob Madsen and Wife Olga Madsen's Foundation.