Interpretation of an evidence-based guideline for the diagnosis and treatment of demyelinating optic neuritis in China (2021)_Chinese Journal of Ocular Fundus Diseases

Authors：

Song Honglu , Wei Shihui , Sun Mingming , Xu Quangang ,  Zhou Huanfen

Department of Ophthalmology, Third Medical Center of Chinese PLA General Hospital, Beijing 100853, China;

Corresponding author：

Zhou Huanfen, Email: zhouzhoueye@163.com

Keywords：

Optic neuritis; Neuromyelitis optica; Practice guidelines as topic; Evidence-based medicine

DOI：

10.3760/cma.j.cn511434-20210830-00475

Video：

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Abstract Full text Figures/Tables Video References Cited by

The first edition of “The Chinese expert consensus on the diagnosis and treatment of optic neuritis” have been published in Chinese Journal of Ophthalmology in 2014. Seven years later, more evidence-based medicine has been accumulated in the treatment of optic neuritis. It is necessary to update or formulate guidelines to guide clinical practice. Based on the methods and procedures for developing evidence -based guidelines, Neuro-Ophthalmology Group of Ophthalmology Branch of Chinese Medical Association and Evidence-based Medicine Centre of Lanzhou University/World Health Organization Collaborating Centre for Guideline Implementation and Knowledge Translation created the first “An evidence-based guideline for the diagnosis and treatment of demyelinating optic neuritis in China (2021)”, which aimed to improve the level of clinical diagnosis and treatments of demyelinating optic neuritis. This guideline proposes a new subtype classification of demyelinating optic neuritis to guide precision treatment. It also gives new suggestions about clinical treatment hotspots in the acute and chronic phases, including the application of immunosuppressants and rituximab and other biological agents.

Citation： Song Honglu, Wei Shihui, Sun Mingming, Xu Quangang, Zhou Huanfen. Interpretation of an evidence-based guideline for the diagnosis and treatment of demyelinating optic neuritis in China (2021). Chinese Journal of Ocular Fundus Diseases, 2021, 37(10): 753-757. doi: 10.3760/cma.j.cn511434-20210830-00475 Copy

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2.	中华医学会眼科学分会神经眼科学组. 视神经炎诊断和治疗专家共识 (2014年)[J]. 中华眼科杂志, 2014, 50(6): 459-463. DOI: 10.3760/cma.j.issn.0412-4081.2014.06.013.Neuro-ophthalmology Group of Ophthalmology Branch of Chinese Medical Association. Expert consensus on diagnosis and treatment of optic neuritis (2014)[J]. Chin J Ophthalmol, 2014, 50(6): 459-463. DOI: 10.3760/cma.j.issn.0412-4081.2014.06.013.
3.	Toosy AT, Mason DF, Miller DH. Optic neuritis[J]. Lancet Neurol, 2014, 13(1): 83-99. DOI: 10.1016/S1474-4422(13)70259-X.
4.	Petzold A, Plant GT. Diagnosis and classification of autoimmune optic neuropathy[J]. Autoimmun Rev, 2014, 13: 539-545. DOI: 10.1016/j.autrev.2014.01.009.
5.	Hassan MB, Stern C, Flanagan EP, et al. Population-based incidence of optic neuritis in the era of aquaporin-4 and myelin oligodendrocyte glycoprotein antibodies[J]. Am J Ophthalmol, 2020, 220: 110-114. DOI: 10.1016/j.ajo.2020.07.014.
6.	中华医学会眼科学分会神经眼科学组, 兰州大学循证医学中心/世界卫生组织指南实施与知识转化合作中心. 中国脱髓鞘性视神经炎诊断和治疗循证指南 (2021年)[J]. 中华眼科杂志, 2021, 57(3): 171-186. DOI: 10.3760/cma.j.cn112142-20201124-00769.Neuro-ophthalmology Group of Ophthalmology Branch of Chinese Medical Association, Evidence-based Medicine Center of Lanzhou University/World Health Organization Collaborating Centre for Guideline Implementation and Knowledge Translation. Evidence-based guidelines for diagnosis and treatment of demyelinating optic neuritis in China (2021)[J]. Chin J Ophthalmol, 2021, 57(3): 171-186. DOI: 10.3760/cma.j.cn112142-20201124-00769.
7.	Beck RW, Cleary PA, Anderson MM, et al. A randomized, controlled trial of corticosteroids in the treatment of acute optic neuritis. The Optic Neuritis Study Group[J]. N Engl J Med, 1992, 326: 581-588. DOI: 10.1056/NEJM199202273260901.
8.	Wakakura M, Ishikawa S, Oono S, et al. Incidence of acute idiopathic optic neuritis and its therapy in Japan. Optic Neuritis Treatment Trial Multicenter Cooperative Research Group (ONMRG)[J]. Nippon Ganka Gakkai Zasshi, 1995, 99: 93-97.
9.	Wingerchuk DM, Banwell B, Bennett JL, et al. International consensus diagnostic criteria for neuromyelitis optica spectrum disorders[J]. Neurology, 2015, 85(2): 177-189. DOI: 10.1212/WNL.0000000000001729.
10.	中国免疫学会神经免疫学分会, 中华医学会神经病学分会神经免疫学组, 中国医师协会神经内科分会神经免疫专业委员会. 中国视神经脊髓炎谱系疾病诊断与治疗指南[J]. 中国神经免疫学和神经病学杂志, 2016, 23(3): 155-166. DOI: 10.3969/j.issn.1006-2963.2016.03.001.The Neuroimmunology Branch of the Chinese Society of Immunology, The Neuroimmunology Group of the Neurology Branch of the Chinese Medical Association, The Neuroimmunology Professional Committee of the Neurology Branch of the Chinese Medical Doctor Association. Guidelines for the diagnosis and treatment of neuromyelitis optica spectrum diseases in China[J]. Chin J Neuroimmunol & Neurol, 2016, 23(3): 155-166. DOI: 10.3969/j.issn.1006-2963.2016.03.001.
11.	Jarius S, Paul F, Aktas O, et al. MOG encephalomyelitis: international recommendations on diagnosis and antibody testing[J/OL]. J Neuroinflammation, 2018, 15(1): 134[2018-05-03]. https://pubmed.ncbi.nlm.nih.gov/29724224/. DOI: 10.1186/s12974-018-1144-2.
12.	López-Chiriboga AS, Majed M, Fryer J, et al. Association of MOG-IgG serostatus with relapse after acute disseminated encephalomyelitis and proposed diagnostic criteria for MOG-IgG-associated disorders[J]. JAMA Neurol, 2018, 75: 1355-1363. DOI: 10.1001/jamaneurol.2018.1814.
13.	中国免疫学会神经免疫分会. 抗髓鞘少突胶质细胞糖蛋白免疫球蛋白G抗体相关疾病诊断和治疗中国专家共识[J]. 中国神经免疫学和神经病学杂志, 2020, 27(2): 86-95. DOI: 10.3969/j.issn.1006-2963.2020.02.002.The Neuroimmunology Branch of the Chinese Society of Immunology. Chinese expert consensus on diagnosis and treatment of diseases related to anti-myelin oligodendrocyte glycoprotein immunoglobulin G antibody[J]. Chin J Neuroimmunol & Neurol, 2020, 27(2): 86-95. DOI: 10.3969/j.issn.1006-2963.2020.02.002.
14.	Thompson AJ, Banwell BL, Barkhof F, et al. Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria[J]. Lancet Neurol, 2018, 17: 162-173. DOI: 10.1016/S1474-4422(17)30470-2.
15.	Petzold A, Plant GT. Chronic relapsing inflammatory optic neuropathy: a systematic review of 122 cases reported[J]. J Neurol, 2014, 261: 17-26. DOI: 10.1007/s00415-013-6957-4.
16.	Zhou H, Zhao S, Yin D, et al. Optic neuritis: a 5-year follow-up study of Chinese patients based on aquaporin-4 antibody status and ages[J]. J Neurol, 2016, 263: 1382-1389. DOI: 10.1007/s00415-016-8155-7.
17.	Bonnan M, Valentino R, Debeugny S, et al. Short delay to initiate plasma exchange is the strongest predictor of outcome in severe attacks of NMO spectrum disorders[J]. J Neurol Neurosurg Psychiatry, 2018, 89: 346-351. DOI: 10.1136/jnnp-2017-316286.
18.	Songthammawat T, Srisupa-Olan T, Siritho S, et al. A pilot study comparing treatments for severe attacks of neuromyelitis optica spectrum disorders: intravenous methylprednisolone (IVMP) with add-on plasma exchange (PLEX) versus simultaneous IVMP and PLEX[J/OL]. Mult Scler Relat Disord, 2020, 38: 101506[2019-11-06]. https://pubmed.ncbi.nlm.nih.gov/31731214/. DOI: 10.1016/j.msard.2019.101506.
19.	Noseworthy JH, O'Brien PC, Petterson TM, et al. A randomized trial of intravenous immunoglobulin in inflammatory demyelinating optic neuritis[J]. Neurology, 2001, 56: 1514-1522. DOI: 10.1212/wnl.56.11.1514.
20.	Ciron J, Audoin B, Bourre B, et al. Recommendations for the use of Rituximab in neuromyelitis optica spectrum disorders[J]. Rev Neurol (Paris), 2018, 174(4): 255-264. DOI: 10.1016/j.neurol.2017.11.005.
21.	Tahara M, Oeda T, Okada K, et al. Safety and efficacy of rituximab in neuromyelitis optica spectrum disorders (RIN-1 study): a multicentre, randomised, double-blind, placebo-controlled trial[J]. Lancet Neurol, 2020, 19: 298-306. DOI: 10.1016/S1474-4422(20)30066-1.
22.	Liu H, Zhou H, Wang J, et al. Antibodies to myelin oligodendrocyte glycoprotein in chronic relapsing inflammatory optic neuropathy[J]. Br J Ophthalmol, 2019, 103: 1423-1428. DOI: 10.1136/bjophthalmol-2018-313142.
23.	Lee HJ, Kim B, Waters P, et al. Chronic relapsing inflammatory optic neuropathy (CRION): a manifestation of myelin oligodendrocyte glycoprotein antibodies[J/OL]. J Neuroinflammation, 2018, 15(1): 302[2018-10-31].https://pubmed.ncbi.nlm.nih.gov/30382857/. DOI: 10.1186/s12974-018-1335-x.
24.	Whittam DH, Cobo-Calvo A, Lopez-Chiriboga AS, et al. Treatment of MOG-IgG-associated disorder with rituximab: an international study of 121 patients[J/OL]. Mult Scler Relat Disord, 2020, 44: 102251[2020-07-02].https://pubmed.ncbi.nlm.nih.gov/32629363/. DOI: 10.1016/j.msard.2020.102251.
25.	Pittock SJ, Berthele A, Fujihara K, et al. Eculizumab in aquaporin-4-positive neuromyelitis optica spectrum disorder[J]. N Engl J Med, 2019, 381: 614-625. DOI: 10.1056/NEJMoa1900866.
26.	Cree BAC, Bennett JL, Kim HJ, et al. Inebilizumab for the treatment of neuromyelitis optica spectrum disorder (N-MOmentum): a double-blind, randomised placebo-controlled phase 2/3 trial[J]. Lancet, 2019, 394: 1352-1363. DOI: 10.1016/S0140-6736(19)31817-3.
27.	Traboulsee A, Greenberg BM, Bennett JL, et al. Safety and efficacy of satralizumab monotherapy in neuromyelitis optica spectrum disorder: a randomised, double-blind, multicentre, placebo-controlled phase 3 trial[J]. Lancet Neurol, 2020, 19(5): 402-412. DOI: 10.1016/S1474-4422(20)30078-8.
28.	Yamamura T, Kleiter I, Fujihara K, et al. Trial of satralizumab in neuromyelitis optica spectrum disorder[J]. N Engl J Med, 2019, 381: 2114-2124. DOI: 10.1056/NEJMoa1901747.
29.	中国免疫学会神经免疫分会, 中华医学会神经病学分会神经免疫学组. 多发性硬化诊断和治疗中国专家共识(2018版)[J]. 中国神经免疫学和神经病学杂志, 2018, 25(6): 387-394. DOI: 10.3969/j.issn.1006-2963.2018.06.001.3969/j. issn. 1006-2963.2018. 06.001 The Neuroimmunology Branch of the Chinese Society of Immunology, The Neuroimmunology Group of the Neurology Branch of the Chinese Medical Association. Chinese expert consensus on the diagnosis and treatment of multiple sclerosis (2018)[J]. Chin J Neuroimmunol & Neurol, 2018, 25(6): 387-394. DOI: 10.3969/j.issn.1006-2963.2018.06.001.

1. 宋宏鲁, 魏世辉. 我国神经眼科发展的现状与挑战[J]. 中国研究型医院, 2021, 8(4): 69-72. DOI: 10.19450/j.cnki.jcrh.2021.04.017.Song HL, Wei SH. Current status and challenges of neuro-ophthalmology development in China[J]. Journal of Chinese Research Hospitals, 2021, 8(4): 69-72. DOI: 10.19450/j.cnki.jcrh.2021.04.017.
2. 中华医学会眼科学分会神经眼科学组. 视神经炎诊断和治疗专家共识 (2014年)[J]. 中华眼科杂志, 2014, 50(6): 459-463. DOI: 10.3760/cma.j.issn.0412-4081.2014.06.013.Neuro-ophthalmology Group of Ophthalmology Branch of Chinese Medical Association. Expert consensus on diagnosis and treatment of optic neuritis (2014)[J]. Chin J Ophthalmol, 2014, 50(6): 459-463. DOI: 10.3760/cma.j.issn.0412-4081.2014.06.013.
3. Toosy AT, Mason DF, Miller DH. Optic neuritis[J]. Lancet Neurol, 2014, 13(1): 83-99. DOI: 10.1016/S1474-4422(13)70259-X.
4. Petzold A, Plant GT. Diagnosis and classification of autoimmune optic neuropathy[J]. Autoimmun Rev, 2014, 13: 539-545. DOI: 10.1016/j.autrev.2014.01.009.
5. Hassan MB, Stern C, Flanagan EP, et al. Population-based incidence of optic neuritis in the era of aquaporin-4 and myelin oligodendrocyte glycoprotein antibodies[J]. Am J Ophthalmol, 2020, 220: 110-114. DOI: 10.1016/j.ajo.2020.07.014.
6. 中华医学会眼科学分会神经眼科学组, 兰州大学循证医学中心/世界卫生组织指南实施与知识转化合作中心. 中国脱髓鞘性视神经炎诊断和治疗循证指南 (2021年)[J]. 中华眼科杂志, 2021, 57(3): 171-186. DOI: 10.3760/cma.j.cn112142-20201124-00769.Neuro-ophthalmology Group of Ophthalmology Branch of Chinese Medical Association, Evidence-based Medicine Center of Lanzhou University/World Health Organization Collaborating Centre for Guideline Implementation and Knowledge Translation. Evidence-based guidelines for diagnosis and treatment of demyelinating optic neuritis in China (2021)[J]. Chin J Ophthalmol, 2021, 57(3): 171-186. DOI: 10.3760/cma.j.cn112142-20201124-00769.
7. Beck RW, Cleary PA, Anderson MM, et al. A randomized, controlled trial of corticosteroids in the treatment of acute optic neuritis. The Optic Neuritis Study Group[J]. N Engl J Med, 1992, 326: 581-588. DOI: 10.1056/NEJM199202273260901.
8. Wakakura M, Ishikawa S, Oono S, et al. Incidence of acute idiopathic optic neuritis and its therapy in Japan. Optic Neuritis Treatment Trial Multicenter Cooperative Research Group (ONMRG)[J]. Nippon Ganka Gakkai Zasshi, 1995, 99: 93-97.
9. Wingerchuk DM, Banwell B, Bennett JL, et al. International consensus diagnostic criteria for neuromyelitis optica spectrum disorders[J]. Neurology, 2015, 85(2): 177-189. DOI: 10.1212/WNL.0000000000001729.
10. 中国免疫学会神经免疫学分会, 中华医学会神经病学分会神经免疫学组, 中国医师协会神经内科分会神经免疫专业委员会. 中国视神经脊髓炎谱系疾病诊断与治疗指南[J]. 中国神经免疫学和神经病学杂志, 2016, 23(3): 155-166. DOI: 10.3969/j.issn.1006-2963.2016.03.001.The Neuroimmunology Branch of the Chinese Society of Immunology, The Neuroimmunology Group of the Neurology Branch of the Chinese Medical Association, The Neuroimmunology Professional Committee of the Neurology Branch of the Chinese Medical Doctor Association. Guidelines for the diagnosis and treatment of neuromyelitis optica spectrum diseases in China[J]. Chin J Neuroimmunol & Neurol, 2016, 23(3): 155-166. DOI: 10.3969/j.issn.1006-2963.2016.03.001.
11. Jarius S, Paul F, Aktas O, et al. MOG encephalomyelitis: international recommendations on diagnosis and antibody testing[J/OL]. J Neuroinflammation, 2018, 15(1): 134[2018-05-03]. https://pubmed.ncbi.nlm.nih.gov/29724224/. DOI: 10.1186/s12974-018-1144-2.
12. López-Chiriboga AS, Majed M, Fryer J, et al. Association of MOG-IgG serostatus with relapse after acute disseminated encephalomyelitis and proposed diagnostic criteria for MOG-IgG-associated disorders[J]. JAMA Neurol, 2018, 75: 1355-1363. DOI: 10.1001/jamaneurol.2018.1814.
13. 中国免疫学会神经免疫分会. 抗髓鞘少突胶质细胞糖蛋白免疫球蛋白G抗体相关疾病诊断和治疗中国专家共识[J]. 中国神经免疫学和神经病学杂志, 2020, 27(2): 86-95. DOI: 10.3969/j.issn.1006-2963.2020.02.002.The Neuroimmunology Branch of the Chinese Society of Immunology. Chinese expert consensus on diagnosis and treatment of diseases related to anti-myelin oligodendrocyte glycoprotein immunoglobulin G antibody[J]. Chin J Neuroimmunol & Neurol, 2020, 27(2): 86-95. DOI: 10.3969/j.issn.1006-2963.2020.02.002.
14. Thompson AJ, Banwell BL, Barkhof F, et al. Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria[J]. Lancet Neurol, 2018, 17: 162-173. DOI: 10.1016/S1474-4422(17)30470-2.
15. Petzold A, Plant GT. Chronic relapsing inflammatory optic neuropathy: a systematic review of 122 cases reported[J]. J Neurol, 2014, 261: 17-26. DOI: 10.1007/s00415-013-6957-4.
16. Zhou H, Zhao S, Yin D, et al. Optic neuritis: a 5-year follow-up study of Chinese patients based on aquaporin-4 antibody status and ages[J]. J Neurol, 2016, 263: 1382-1389. DOI: 10.1007/s00415-016-8155-7.
17. Bonnan M, Valentino R, Debeugny S, et al. Short delay to initiate plasma exchange is the strongest predictor of outcome in severe attacks of NMO spectrum disorders[J]. J Neurol Neurosurg Psychiatry, 2018, 89: 346-351. DOI: 10.1136/jnnp-2017-316286.
18. Songthammawat T, Srisupa-Olan T, Siritho S, et al. A pilot study comparing treatments for severe attacks of neuromyelitis optica spectrum disorders: intravenous methylprednisolone (IVMP) with add-on plasma exchange (PLEX) versus simultaneous IVMP and PLEX[J/OL]. Mult Scler Relat Disord, 2020, 38: 101506[2019-11-06]. https://pubmed.ncbi.nlm.nih.gov/31731214/. DOI: 10.1016/j.msard.2019.101506.
19. Noseworthy JH, O'Brien PC, Petterson TM, et al. A randomized trial of intravenous immunoglobulin in inflammatory demyelinating optic neuritis[J]. Neurology, 2001, 56: 1514-1522. DOI: 10.1212/wnl.56.11.1514.
20. Ciron J, Audoin B, Bourre B, et al. Recommendations for the use of Rituximab in neuromyelitis optica spectrum disorders[J]. Rev Neurol (Paris), 2018, 174(4): 255-264. DOI: 10.1016/j.neurol.2017.11.005.
21. Tahara M, Oeda T, Okada K, et al. Safety and efficacy of rituximab in neuromyelitis optica spectrum disorders (RIN-1 study): a multicentre, randomised, double-blind, placebo-controlled trial[J]. Lancet Neurol, 2020, 19: 298-306. DOI: 10.1016/S1474-4422(20)30066-1.
22. Liu H, Zhou H, Wang J, et al. Antibodies to myelin oligodendrocyte glycoprotein in chronic relapsing inflammatory optic neuropathy[J]. Br J Ophthalmol, 2019, 103: 1423-1428. DOI: 10.1136/bjophthalmol-2018-313142.
23. Lee HJ, Kim B, Waters P, et al. Chronic relapsing inflammatory optic neuropathy (CRION): a manifestation of myelin oligodendrocyte glycoprotein antibodies[J/OL]. J Neuroinflammation, 2018, 15(1): 302[2018-10-31].https://pubmed.ncbi.nlm.nih.gov/30382857/. DOI: 10.1186/s12974-018-1335-x.
24. Whittam DH, Cobo-Calvo A, Lopez-Chiriboga AS, et al. Treatment of MOG-IgG-associated disorder with rituximab: an international study of 121 patients[J/OL]. Mult Scler Relat Disord, 2020, 44: 102251[2020-07-02].https://pubmed.ncbi.nlm.nih.gov/32629363/. DOI: 10.1016/j.msard.2020.102251.
25. Pittock SJ, Berthele A, Fujihara K, et al. Eculizumab in aquaporin-4-positive neuromyelitis optica spectrum disorder[J]. N Engl J Med, 2019, 381: 614-625. DOI: 10.1056/NEJMoa1900866.
26. Cree BAC, Bennett JL, Kim HJ, et al. Inebilizumab for the treatment of neuromyelitis optica spectrum disorder (N-MOmentum): a double-blind, randomised placebo-controlled phase 2/3 trial[J]. Lancet, 2019, 394: 1352-1363. DOI: 10.1016/S0140-6736(19)31817-3.
27. Traboulsee A, Greenberg BM, Bennett JL, et al. Safety and efficacy of satralizumab monotherapy in neuromyelitis optica spectrum disorder: a randomised, double-blind, multicentre, placebo-controlled phase 3 trial[J]. Lancet Neurol, 2020, 19(5): 402-412. DOI: 10.1016/S1474-4422(20)30078-8.
28. Yamamura T, Kleiter I, Fujihara K, et al. Trial of satralizumab in neuromyelitis optica spectrum disorder[J]. N Engl J Med, 2019, 381: 2114-2124. DOI: 10.1056/NEJMoa1901747.
29. 中国免疫学会神经免疫分会, 中华医学会神经病学分会神经免疫学组. 多发性硬化诊断和治疗中国专家共识(2018版)[J]. 中国神经免疫学和神经病学杂志, 2018, 25(6): 387-394. DOI: 10.3969/j.issn.1006-2963.2018.06.001.3969/j. issn. 1006-2963.2018. 06.001 The Neuroimmunology Branch of the Chinese Society of Immunology, The Neuroimmunology Group of the Neurology Branch of the Chinese Medical Association. Chinese expert consensus on the diagnosis and treatment of multiple sclerosis (2018)[J]. Chin J Neuroimmunol & Neurol, 2018, 25(6): 387-394. DOI: 10.3969/j.issn.1006-2963.2018.06.001.

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Interpretation of an evidence-based guideline for the diagnosis and treatment of demyelinating optic neuritis in China (2021)

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