Immunoglobulins as steroid sparing agents in chronic relapsing inflammatory optic neuropathy

Luis I Gonzalez-Granado

doi:10.4103/0972-2327.64629


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LETTER TO THE EDITOR

Year : 2010 \| Volume : 13 \| Issue : 2 \| Page : 152

Immunoglobulins as steroid sparing agents in chronic relapsing inflammatory optic neuropathy

Luis I Gonzalez-Granado
Immunodeficiencies Unit, Hospital 12 octubre, Carretera Andalucia km 5,400, P.O. 28041, Madrid, Spain

Date of Web Publication

25-Jun-2010

Correspondence Address:
Luis I Gonzalez-Granado
Immunodeficiencies Unit, Hospital 12 octubre, Carretera Andalucia km 5,400, P.O. 28041, Madrid
Spain

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/0972-2327.64629

How to cite this article:
Gonzalez-Granado LI. Immunoglobulins as steroid sparing agents in chronic relapsing inflammatory optic neuropathy. Ann Indian Acad Neurol 2010;13:152

How to cite this URL:
Gonzalez-Granado LI. Immunoglobulins as steroid sparing agents in chronic relapsing inflammatory optic neuropathy. Ann Indian Acad Neurol [serial online] 2010 [cited 2020 Oct 30];13:152. Available from: https://www.annalsofian.org/text.asp?2010/13/2/152/64629

Sir,

I read with great interest the case reported by Drs Saini and Khurana titled "Chronic relapsing inflammatory optic neuropathy".^[1] I do really appreciate their contribution to the knowledge of chronic relapsing inflammatory optic neuropathy. However, after reading the case I have one main concern: long-term management. It is well known that steroids can prevent reactivation of chronic relapsing inflammatory optic neuropathy. Nonetheless, we should be aware of the severe adverse effects that long-term steroids can induce in these patients. Therefore, there is an increasing interest in the use of intravenous immunoglobulins as steroid-sparing agents, as they have been demonstrated to be effective in the treatment of idiopathic inflammatory neuropathies including Guillain-Barrι syndrome, chronic inflammatory demyelinating neuropathy and multifocal motor neuropathy (MMN; in this case represents the gold standard for treatment).^[2],[3] In the past, other steroid-sparing agents have been used with mild to severe side effects (methotrexate, cyclophosphamide, azathioprine - the most used drug within this group - and mycophenylate).^[4],[5] The authors could argue that deflazacort was administered on alternate days. Nevertheless, the anti-inflammatory effect is 30% higher compared with prednisolone and a better risk/benefit ratio has only been demonstrated for the bone-sparing effect.^[6]

This is why steroid sparing agents should be strongly considered (especially i.v. immunoglobulins) for the management of this condition.

References

1.	Saini M, Khurana D. Chronic relapsing inflammatory optic neuropathy. Ann Indian Acad Neurol 2010;13:61-3. [PUBMED]
2.	Stiebel-Kalish H, Hammel N, van Everdingen J, Huna-Baron R, Lee AG. Intravenous immunoglobulin in recurrent-relapsing inflammatory optic neuropathy. Can J Ophthalmol 2010;45:71-5. [PUBMED] [FULLTEXT]
3.	Nobile-Orazio E, Terenghi F. IVIg in idiopathic autoimmune neuropathies: analysis in the light of the latest results. J Neurol 2005;252:I7-13. [PUBMED] [FULLTEXT]
4.	Myers TD, Smith JR, Wertheim MS, Egan RA, Shults WT, Rosenbaum JT. Use of corticosteroid sparing systemic immunosuppression for treatment of corticosteroid dependent optic neuritis not associated with demyelinating disease. Br J Ophthalmol 2004;88:673-80. [PUBMED] [FULLTEXT]
5.	Smith JR, Rosenbaum JT. A role for methotrexate in the management of non-infectious orbital inflammatory disease. Br J Ophthalmol 2001;85:1220-4. [PUBMED] [FULLTEXT]
6.	Gennari C. Differential effect of glucocorticoids on calcium absorption and bone mass. Br J Rheumatol 1993;32:11-4. [PUBMED] [FULLTEXT]