Abstract: Treatment of Acute Optic Neuritis and MS Relapses: A Survey of Clinician Attitudes, Perspectives, and Clinical Reasoning (2022 Annual Meeting of the Consortium of Multiple Sclerosis Centers)

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Treatment of Acute Optic Neuritis and MS Relapses: A Survey of Clinician Attitudes, Perspectives, and Clinical Reasoning

Thursday, June 2, 2022

Prince George's Exhibit Hall (Gaylord National Resort & Convention Center)

Emily M Schorr, MD , Dept. of Neurology, Johns Hopkins School of Medicine, Baltimore, MD

Nicole Bou Rjeily, MD , Dept. of Neurology, Johns Hopkins School of Medicine, Baltimore, MD

Alexander Brandt, MD , Dept. of Neurology, University of California, Irvine, School of Medicine, Irvine, CA

Vivek Patel, MD , Div. of Neuro-Ophthalmology, USC Roski Eye Inst., Keck School of Medicine, Los Angeles, CA

Laura Balcer, MD MSCE , Dept. of Neurology, New York University Grossman School of Medicine, New York, NY

June Halper, MSN, APN-C, MSCN, FAAN , Consortium of Multiple Sclerosis Centers, Hackensack, NJ

Mark S Freedman, MSc, MD , Department of Medicine and the Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada

Friedemann Paul, MD , Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine and Charité Universitätsmedizin Berlin, Berlin, Germany

Pablo Villoslada, MD, PhD , Dept. of Psychiatry and Behavioural Sciences & Dept. of Neurology and Neurological Sciences, Stanford University, Stanford, CA

Ann Yeh, M.D. , Dept. of Paediatrics, Div. of Neurology, The Hospital for Sick Children, Toronto, ON, Canada

Robert A Bermel, MD , Mellen Center for MS, Cleveland Clinic, Cleveland, OH

Axel Petzold, MD, PhD , UCL Institute of Neurology, London, United Kingdom

Jennifer Graves, MD PhD MAS , Dept. of Neurology, University of California San Diego, San Diego, CA

Philipp Albrecht, MD , Dept. of Neurology, Heinrich Heine University Dusseldorf, Dusseldorf, Germany

Rachel Nolan-Kenney, BA , Dept. of Neurology, New York University Grossman School of Medicine, New York, NY

Peter Calabresi, MD , Dept. of Neurology, Johns Hopkins School of Medicine, Baltimore, MD

Ellen M Mowry, MD, MCR , Dept. of Neurology, Johns Hopkins School of Medicine, Baltimore, MD

Scott D. Newsome, DO, MSCS, FAAN, FANA , Dept. of Neurology, Johns Hopkins School of Medicine, Baltimore, MD

Kathryn C Fitzgerald, ScD , Dept. of Neurology, Johns Hopkins School of Medicine, Baltimore, MD

Shiv Saidha, MBBCh, MD, MRCPI , Dept. of Neurology, Johns Hopkins School of Medicine, Baltimore, MD

Background: Acute optic neuritis (AON) is a common presentation in demyelinating diseases such as MS. Visual pathway evaluation allows relatively specific and comparable outcome assessment across studies. AON study results are often extrapolated to MS relapses in general. AON treatment is largely based on the Optic Neuritis Treatment Trial (ONTT), conducted in the 1980s, which demonstrated faster recovery but no sustained functional outcome benefit with IV methylprednisolone (IVMP) vs. placebo, or low dose oral prednisone (LDOP). Structural outcomes and high dose oral prednisone (HDOP) were not assessed. Most subsequent studies have similarly not shown long-term benefits from steroids. Debate persists about AON and MS relapse management. Understanding current practice and perspectives is critical to guide future research.

Objectives: To assess provider-reported AON treatment practices and decision-making factors.

Methods: In March-April 2022, a 25-question multiple-choice anonymous survey was emailed to all members of CMSC, ACTRIMS, and IMSVISUAL. Results are summarized with descriptive statistics.

Results: The 291 respondents included neuroimmunologists (74%), general neurologists (17%), and neuro-ophthalmologists (5%). Most were from the US (41%) or Europe (29%). Most clinicians (69%) leverage ONTT results for treating MS relapses; 97% endorsed that corticosteroids for typical ON have beneficial effects including faster recovery (85%), improvement in clinical function (52%), neuroprotection (11%), and/or reduced conversion to clinically definite MS (9%). Treatment options for typical AON included IVMP (79%), HDOP (41%), LDOP (3%), IVIG (9%), plasmapheresis (25%) or no treatment (10%). The majority of clinicians (62%) almost always treat AON with steroids. Commonly cited individual factors considered for treatment included severity of visual disturbance (45%), poor recovery from a previous relapse (41%) and time since AON onset (32%). Lastly, 88% endorsed an evidence gap, and that a study with sensitive structural and functional outcomes assessing steroid treatment in AON would be impactful for their practice.

Conclusions: There is significant heterogeneity in interpretation of the ONTT and other AON studies, and varied approaches to AON treatment. Most clinicians endorse an evidence gap regarding optimal AON treatment—particularly concerning since most use AON data to guide treatment of MS relapses in general. Our findings suggest that an AON study with broader treatment interventions and sensitive structural and functional outcomes may help address this need.

8383 Treatment of Acute Optic Neuritis and MS Relapses: A Survey of Clinician Attitudes, Perspectives, and Clinical Reasoning

8383
Treatment of Acute Optic Neuritis and MS Relapses: A Survey of Clinician Attitudes, Perspectives, and Clinical Reasoning