Abstract General Information

Title

High-dose oral methylprednisolone treatment for AQP4 positive NMOSD attacks

Abstract

Introduction: High-dose intravenous corticosteroids are commonly used as the primary treatment for acute attacks of central nervous system demyelinating diseases. Also, oral bioequivalent regimens of high-dose methylprednisolone have been shown to be non-inferior in multiple sclerosis attacks, with potential benefits of cost reduction and improved patient experience. Despite this, there is a lack of studies evaluating the efficacy of high-dose oral methylprednisolone (OM) in neuromyelitis optica spectrum disorder (NMOSD) attacks.

Objectives: The objective of this retrospective observational study was to evaluate the efficacy of high-dose OM treatment for mild NMOSD attacks.

Methods: Electronic medical records from January 2021 to March 2023 were retrospectively reviewed for outpatients diagnosed with AQP4-positive NMOSD (according to the IPND 2015 criteria) who received 3 to 5 days of 1g/day of OM for the treatment of attacks. Data on age, sex, clinical syndrome and EDSS increase were extracted. The primary outcome was efficacy, which was evaluated by the proportion of patients with complete recovery and the proportion of patients who required additional immunotherapy with intravenous steroids and plasma exchange.

Results: Thirteen women with a median age of 47 received high-dose OM. Clinical syndromes were most frequently myelitis (7/13, 54%) and optic neuritis (4/13, 31%). The increase in EDSS during the attacks ranged from 0 to 1 point, with no change in the EDSS median (3.0). Complete recovery of the attacks was observed in 4/13 (31%) of patients. However, minimal/no recovery or worsening led to additional intravenous steroid and plasma exchange in 5/13 (38%) of participants.

Conclusion: In this case series of mild attacks of AQP4-positive NMOSD attacks, treatment with high-dose OM resulted in complete recovery in one-third of patients. However, one-third of patients required additional immunotherapy, and close follow-up is recommended when prescribing high-dose OM for NMOSD attacks.