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J. Pasol, W. J. Feuer, J. Guy, G. Shaw; Serum Levels of the Phosphorylated Neurofilament Heavy Chain Biomarker of Axonal Injury is Reduced 5 Years After Treatment by Intravenous Methylprednisolone in the Optic Neuritis Treatment Trial. Invest. Ophthalmol. Vis. Sci. 2010;51(13):636.
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© ARVO (1962-2015); The Authors (2016-present)
To assess axonal loss in patients entered into the optic neuritis treatment trial (ONTT).
The Optic Neuritis Treatment Trial randomized 389 patients with acute optic neuritis to intravenous methylprednisolone (IVMP), oral prednisone or placebo treatment arms. We measured serum pNF-H levels in 175 ONTT patients. 63 patients received IVMP, 63 patients received prednisone and 49 patients received placebo. Venous blood was drawn 5 years after enrollment. Optical coherence tomography (OCT) was performed 10 years later.
Post-hoc least significant difference tests revealed lower pNF-H with IVMP relative to placebo (difference = -0.067; p = 0.047) or prednisone (difference = -0.073, p= 0.021). There was no difference (p = 0.75) between cases with or without MS at 5 years. A subset of 51 patients had retinal nerve fiber layer (RNFL) measurements at year 15 that constituted another outcome variable. There was no significant difference of mean IVMP RNFL=81 µm (n= 18), 78 µm with prednisone (n=18) or 71 mm placebo (n=15). In the subset with RNFL measurements of affected and non-affected eyes of patients with CDMS (n=20), respectively 69 mm and 82 mm, were significantly different (respectively p=0.018 and p=0.001) from those without CDMS, respectively 83 µm and 99 µm (n=31). There was no correlation of the number of T2W MRI brain lesions to pNF-H levels. We found no statistical correlation of pNF-H levels to recovery of visual acuity at 6 months or RNFL thickness at 15 years in patients with or without MS.
We conclude that IVMP had a small but measurable effect on suppressing neurodegeneration in optic neuritis.
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