NANOSNET

Michel,

This is an excellent and timely question. Many retrospective studies have suggested that early plasma exchange (PLEX) is associated with improved outcomes. However, these studies are subject to potential bias. Patients treated early with PLEX may have recovered without treatment, whereas patients receiving PLEX later (e.g., at one month because vision remains poor) already represent a subset more likely to have worse outcomes. The AAO recently came out with a statement on plasma exchange for optic neuritis, with a large caveat that the current evidence is largely dependent on retrospective studies.  Visual Outcomes of Plasma Exchange for Acute Optic Neuritis: A Report by the American Academy of Ophthalmology - ScienceDirect

To better answer this question, we need a randomized clinical trial comparing early vs delayed rescue PLEX.  There is a PCORI-funded trial with 31 sites around the US that is just starting to enroll patients (TIMELY-PLEX) that will answer this question.  This website includes the sites that will be enrolling patients (about half of the sites are active with the plan to have the remaining sites active within the next couple of months).  About TIMELY-PLEX Trial - TIMELY-PLEX

I have a one-page info sheet about the TIMELY-PLEX trial attached.  The main inclusion criteria is an adult patient (>=18) with optic neuritis a visual acuity of 20/200 or worse with symptom onset within 8 days.  Patients will be randomized to:

1) "Traditional" or "Rescue PLEX" approach: initial treatment with steroids, with escalation to PLEX if there is an insufficient response to steroids (decision point at 14 days)

2)"Early PLEX" approach: treatment with steroids and PLEX initiated concurrently at the time of clinical presentation

If anyone has any patients with acute severe optic neuritis, please see if there is a nearby site that is enrolling in the TIMELY-PLEX trial.  Please feel free to reach out to me with any questions about the trial (chen.john@mayo.edu).

Best,

John

Michel,

This is an excellent and timely question. Many retrospective studies have suggested that early plasma exchange (PLEX) is associated with improved outcomes. However, these studies are subject to potential bias. Patients treated early with PLEX may have recovered without treatment, whereas patients receiving PLEX later (e.g., at one month because vision remains poor) already represent a subset more likely to have worse outcomes. The AAO recently came out with a statement on plasma exchange for optic neuritis, with a large caveat that the current evidence is largely dependent on retrospective studies.  Visual Outcomes of Plasma Exchange for Acute Optic Neuritis: A Report by the American Academy of Ophthalmology - ScienceDirect

To better answer this question, we need a randomized clinical trial comparing early vs delayed rescue PLEX.  There is a PCORI-funded trial with 31 sites around the US that is just starting to enroll patients (TIMELY-PLEX) that will answer this question.  This website includes the sites that will be enrolling patients (about half of the sites are active with the plan to have the remaining sites active within the next couple of months).  About TIMELY-PLEX Trial - TIMELY-PLEX

I have a one-page info sheet about the TIMELY-PLEX trial attached.  The main inclusion criteria is an adult patient (>=18) with optic neuritis a visual acuity of 20/200 or worse with symptom onset within 8 days.  Patients will be randomized to:

1) "Traditional" or "Rescue PLEX" approach: initial treatment with steroids, with escalation to PLEX if there is an insufficient response to steroids (decision point at 14 days)

2)"Early PLEX" approach: treatment with steroids and PLEX initiated concurrently at the time of clinical presentation

If anyone has any patients with acute severe optic neuritis, please see if there is a nearby site that is enrolling in the TIMELY-PLEX trial.  Please feel free to reach out to me with any questions about the trial (chen.john@mayo.edu).

Best,

John

Michel,

This is an excellent and timely question. Many retrospective studies have suggested that early plasma exchange (PLEX) is associated with improved outcomes. However, these studies are subject to potential bias. Patients treated early with PLEX may have recovered without treatment, whereas patients receiving PLEX later (e.g., at one month because vision remains poor) already represent a subset more likely to have worse outcomes. The AAO recently came out with a statement on plasma exchange for optic neuritis, with a large caveat that the current evidence is largely dependent on retrospective studies.  Visual Outcomes of Plasma Exchange for Acute Optic Neuritis: A Report by the American Academy of Ophthalmology - ScienceDirect

To better answer this question, we need a randomized clinical trial comparing early vs delayed rescue PLEX.  There is a PCORI-funded trial with 31 sites around the US that is just starting to enroll patients (TIMELY-PLEX) that will answer this question.  This website includes the sites that will be enrolling patients (about half of the sites are active with the plan to have the remaining sites active within the next couple of months).  About TIMELY-PLEX Trial - TIMELY-PLEX

I have a one-page info sheet about the TIMELY-PLEX trial attached.  The main inclusion criteria is an adult patient (>=18) with optic neuritis a visual acuity of 20/200 or worse with symptom onset within 8 days.  Patients will be randomized to:

1) "Traditional" or "Rescue PLEX" approach: initial treatment with steroids, with escalation to PLEX if there is an insufficient response to steroids (decision point at 14 days)

2)"Early PLEX" approach: treatment with steroids and PLEX initiated concurrently at the time of clinical presentation

If anyone has any patients with acute severe optic neuritis, please see if there is a nearby site that is enrolling in the TIMELY-PLEX trial.  Please feel free to reach out to me with any questions about the trial (chen.john@mayo.edu).

Best,

John