Autoantibody profile (MOG-IgG-positivity, AQP4-IgG-positivity, and double-seronegativity) as an outcome predictor after optic neuritis

Abstract

Background

Optic neuritis (ON) is the leading cause of optic neuropathy among young adults. Approximately 45 % of these patients have autoantibodies, and their possible clinical and prognostic implications have not been completely elucidated.

Objective

We aimed to assess the visual outcome and its predictors in a cohort of patients with optic neuritis as a clinically isolated syndrome according to their antibody profile: AQP4-IgG-positivity, MOG-IgG-positivity, and double-seronegativity (SN).

Methods and material

This cohort study used partial retrospective data collection from the neuroimmunology outpatient clinic of the University of São Paulo Hospital, including consecutive cases of isolated inflammatory ON. All samples were tested for MOG and AQP4 antibodies using in-house cell-based assays in live HEK-293 cells. This study was conducted following the STROBE guidelines.

Results

Forty-seven consecutive patients were included in this study. The number of patients with visual acuity (VA) worse than 20/200 during acute attacks was similar among the three groups. However, severe long-term disability (20/200) was less frequent in patients with MOG-IgG (AQP4-IgG group: 58 %, MOG-IgG group: 15 %, SN group: 54 %; p = 0.029). After adjusting for age and attack severity, MOG-IgG status was associated with a 30.9 % higher relative VA improvement (95 %CI 7.5 – 54.3 %, p = 0.011) than the other subgroups.

Conclusions

Severe visual acuity disability was less frequent in the MOG-IgG group than in the AQP4-IgG and SN groups. Positivity for these antibodies was the only predictor of long-term VA in patients with isolated ON (single or recurrent).