Abstract Details

Title Bilateral Optic Neuritis in MOGAD: Treatment Patterns and Relapse Outcomes

Topic Autoimmune Neurology

Presentation(s) P3 - Poster Session 3 (5:00 PM-6:00 PM)

Poster/Presentation
Number 1-008

Objective Evaluate whether bilateral optic neuritis (BON) at MOGAD onset represents a distinct phenotype requiring more aggressive treatment and assess the impact of early maintenance therapy on relapse risk.

Background BON is a common presentation in MOGAD, but optimal treatment strategies remain unclear. We hypothesised that BON represents a higher-risk phenotype warranting aggressive acute treatment and early maintenance therapy initiation.

Design/Methods Retrospective single-centre cohort study of 141 MOGAD patients (51 BON, 90 unilateral ON [UON]) with median follow-up of 18.1 months. We compared treatment patterns, including acute therapies (IVMP, IVIG, PLEX) and early maintenance initiation (<90 days), between groups. Cox proportional hazards models assessed relapse risk adjusting for age, sex, acute treatment intensity, and maintenance therapy timing.

Results BON patients received significantly more aggressive treatment than UON: IVMP (90.2% vs 74.4%, p=0.024), PLEX (23.5% vs 10.0%, p=0.030), aggressive acute therapy with IVIG/PLEX (27.5% vs 12.2%, p=0.041), and early maintenance therapy (51.0% vs 25.6%, p=0.003). With more intensive treatment, BON patients had numerically lower crude relapse rates (37.3% vs 48.9%). In adjusted Cox models, BON showed no significant difference in relapse risk compared to UON (HR=0.92, 95%CI: 0.49-1.74, p=0.807). Early maintenance therapy showed a trend toward reduced relapse risk (HR=0.68, 95%CI: 0.33-1.38, p=0.286), as did aggressive acute treatment (HR=0.44, 95%CI: 0.16-1.22, p=0.114), though neither reached statistical significance. No significant interaction was found between BON status and early maintenance therapy (interaction HR=0.72, p=0.610).

Conclusions BON patients receive substantially more aggressive acute and preventive treatment in clinical practice, likely reflecting perceived higher risk. After adjustment for treatment differences, BON and UON patients have similar relapse risks, suggesting that current intensive treatment approaches may be appropriately mitigating risk in BON. Early maintenance therapy and aggressive acute treatment show trends toward benefit that warrant investigation in larger prospective studies. These findings support risk-stratified treatment approaches based on initial presentation phenotype.

Authors/Disclosures
Tony Alocious PRESENTER	Mr. Alocious has nothing to disclose.
Philippe-Antoine Bilodeau, MD (Massachusetts General Hospital)	Dr. Bilodeau has nothing to disclose.
Anastasia Vishnevetsky, MD (Massachusetts General Hospital)	The institution of Dr. Vishnevetsky has received research support from National MS Society. The institution of Dr. Vishnevetsky has received research support from NIH (NeuroNext).
Takahisa Mikami, MD (Massachusetts General Hospital)	Dr. Mikami has nothing to disclose.
Monique Anderson, MD, PhD (Mass General Hospital)	Dr. Anderson has nothing to disclose.
James V. Nguyen, MD, MEd (Mass General Brigham)	Dr. Nguyen has nothing to disclose.
Joao Vitor Mahler, MD	Dr. Mahler has received research support from The Sumaira Foundation.
Gabriela Romanow (Massachusetts General Hospital)	Gabriela Romanow has nothing to disclose.
Rebecca Salky	Rebecca Salky has nothing to disclose.
Rebecca L. Gillani, MD (Massachusetts General Hospital)	The institution of Dr. Gillani has received research support from The Phyllis and Jerome Lyle Rappaport Foundation. The institution of Dr. Gillani has received research support from McCourt Foundation . The institution of Dr. Gillani has received research support from Roche.
Mattia Wruble, MD	The institution of Dr. Wruble has received research support from Alexion. The institution of Dr. Wruble has received research support from Roche.
Michael Levy, MD, PhD, FAAN (Massachusetts General Hospital/Harvard Medical School)	Dr. Levy has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Mitsubishi Pharma. Dr. Levy has received personal compensation in the range of $500-$4,999 for serving as a Consultant for UCB Pharma. Dr. Levy has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Sanofi. Dr. Levy has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion. Dr. Levy has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Horizon. Dr. Levy has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genentech. Dr. Levy has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Elsevier. Dr. Levy has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Various law firms. The institution of Dr. Levy has received research support from National Institutes Health.

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