To determine the utility of plasmapheresis in the treatment of acute optic neuritis associated with myelin oligodendrocyte glycoprotein (MOG) antibodies.

Optic neuritis is a principal demyelinating manifestation of MOG-antibody disease (MOGAD), and acute attacks are commonly treated with corticosteroids. As with other antibody-mediated diseases, plasmapheresis may offer additional treatment benefits beyond corticosteroid monotherapy, but only limited data is available to guide its use in MOGAD.

Patients with MOGAD were included if they experienced an acute attack of optic neuritis managed with corticosteroids or combination of corticosteroids and plasmapheresis. Wilcoxon rank-sum and Kruskal-Wallis tests were applied for univariate analyses. Linear regressions were applied for multivariate analyses.

Thirty-seven patients with a median age of 42 years (IQR 30-53 years) were included, 15 of whom received plasmapheresis. The median delay to presentation and to plasmapheresis initiation from hospital admission was 8 and 5 days, respectively. In the univariate analyses, pheresed patients were likely to have a greater reduction in the visual acuity extended disability status scale (VA EDSS) at hospital discharge (p=0.002) and at 3-month follow-up (p=0.004). A shorter delay to plasmapheresis from the time of symptom onset was associated with a greater reduction in VA EDSS at 3-month follow-up (p=0.04). In the multivariate analyses, the mean VA EDSS of pheresed patients was 1.48 points lower (95% CI, 0.34-2.61, p=0.02) at hospital discharge and 1.86 points lower at 3-month follow-up (95% CI, 0.30-3.43, p=0.05) than nonpheresed patients. Patients with shorter duration to presentation were more likely to benefit by the time of hospital discharge (p<0.001) and to have a sustained visual benefit at 3 month follow-up (p<0.001).