From the Guidelines
Intravenous Immunoglobulin (IVIG) may be considered as a treatment option for optic neuritis, particularly in patients with MOG-IgG-associated encephalomyelitis (MOG-EM) or those who are unresponsive to corticosteroids. The use of IVIG in optic neuritis is supported by evidence suggesting its effectiveness in reducing inflammation and modulating the immune response 1. According to the study, patients positive for MOG-IgG might be particularly responsive to antibody-depleting treatments, including IVIG, especially in children 1.
Key Points to Consider
- IVIG is not a first-line treatment for optic neuritis, and its use should be considered on a case-by-case basis.
- The standard treatment for acute optic neuritis typically involves high-dose intravenous methylprednisolone, sometimes followed by an oral prednisone taper.
- IVIG may be considered in specific cases where patients have failed to respond to corticosteroids, particularly in steroid-unresponsive cases or in patients with certain autoimmune conditions like MOG-EM.
- When used, IVIG is typically administered at a dose of 0.4 g/kg/day for 5 consecutive days, though protocols may vary.
Rationale for IVIG Use
The rationale behind using IVIG in select cases of optic neuritis is its immunomodulatory effects, including neutralization of pathogenic antibodies, inhibition of complement activation, and regulation of T-cell function 1. However, evidence supporting IVIG use specifically for optic neuritis is limited compared to the well-established benefit of corticosteroids. Patients with optic neuritis should be evaluated promptly by a neurologist or neuro-ophthalmologist to determine the most appropriate treatment based on their specific clinical presentation and underlying cause.
From the Research
Treatment of Optic Neuritis with IVIG
- The use of Intravenous Immunoglobulin (IVIG) as a treatment for optic neuritis has been explored in several studies 2, 3.
- A study published in 2008 found that IVIG treatment resulted in significant improvement in visual acuity in patients with corticosteroid-refractory optic neuritis, with 78% of patients achieving near normal vision 2.
- A more recent study published in 2021 found that IVIG treatment was effective in improving visual acuity in patients with steroid-resistant optic neuritis, with 75% of patients showing improvement in visual acuity compared to 31.3% in the steroid pulse group 3.
Comparison with Corticosteroids
- Corticosteroids are currently the standard treatment for optic neuritis, and several studies have compared the efficacy of IVIG with corticosteroids 4, 5, 6.
- A study published in 2018 found that bioequivalent doses of oral corticosteroids may be used as an alternative to IV corticosteroids to treat acute optic neuritis, but did not investigate the use of IVIG 4.
- Another study published in 2020 found that rapid administration of high-dose intravenous methylprednisolone improved visual outcomes in patients with AQP4-IgG-positive NMOSD, but did not compare this treatment with IVIG 6.
Efficacy and Safety of IVIG
- The studies that investigated the use of IVIG for optic neuritis found it to be a safe and efficacious treatment option 2, 3.
- The 2021 study found that IVIG treatment resulted in significant improvement in visual acuity and mean deviation values, with no clinically significant adverse events reported 3.