AB1148 Biological treatment of non ischaemic optic neuritisassociated to immune-mediated inflammatory diseases. multicenter study

Background Non ischaemic optic neuritis (NION) is a severe inflammation of the optic nerve that may lead to blindness. It can be primary or associated to immune-mediated inflammatory diseases (IMIDs). The treatment of the NION is based on systemic corticosteroids and conventional immunosuppressive drugs. Objectives To assess the efficacy of the biological treatment in refractory NION to conventional treatment. Methods Multicenter study of 8 patients diagnosed with NION refractory to systemic corticosteroids and at least one conventional immunosuppressive drug. The main outcomes were visual acuity (VA) and OCT of the optic nerve and the ganglionar cells. Comparisons were made between baseline and the 1st week, 1st and 6th month and 1st year. (STATISTICA, StatSoft Inc. Tulsa, Oklahoma, USA). Results We studied 8 patients (12 affected eyes) (4♀/4♂); mean age of 34.37±13.30 years. The underlying diseases were SLE (n=1), neuromyelitis optica (n=1), neuroretinitis (n=1), relapsing polychondritis (n=1), idiopathic (n=2) and Behcet’s disease (n=2). Before biological treatment and besides oral corticosteroids patients had received intravenous (IV) methylprednisolone boluses (n=6), cyclosporine A (CyA) (n=1), ciclophosphamide (n=2), micophenolate (n=2), hydroxycloroquine (n=1), methotrexate (MTX) (n=4) and azathioprine (AZA) (n=2). Biological treatment was based on rituximab (n=2) (2 IV. doses of 1 g/very 2 weeks and every 6 months), adalimumab (n=2) 40 mg/week, tocilizumab (n=2) 8 mg/kg/2–4 weeks and infliximab (n=2) 5 mg/kg at 0, 2 and 6 week and then every 8 weeks. The characteristics of the 8 patients are shown in the TABLE After biological treatment we observed an improvement in the ocular parameters: VA [0.60±0.33 to 0.76±0.41, p: 0.04], OCT of the optic nerve [130.63±60.54 to 102.60±8.17, p: 0.1] and OCT of the ganglionar cells [404.60±184.73 to 243±18.38, p: 0.17] at one year. After a mean follow-up of 27±14.47 months there were no severe adverse effects. Conclusions This study shows that treatment with biologic drugs, including ant-TNF drugs, in NION associated to IMIDs, refractory to conventional treatment, seems to be effective. These results must be confirmed in prospective and randomised trials. Disclosure of Interest None declared