Criteria for the use of plasmapheresesis in optic neuritis: A practice review from French expert centers - 16/07/25

Doi : 10.1016/j.neurol.2025.06.005

A. Gaulier ^a,⁎ , V. Touitou ^b, M.-B. Rougier ^c, M.P. Robert ^d, H. Merle ^e, M. Aubart ^d, P. Cabre ^e, C. Cochard ^g, N. Stolowy ^h, J. De Seze ⁱ, A. Gueguen ^f, J. Aboab ^j, H. Zephir ^k, A. Ungureanu ^l, A. Caignard ^m, C. Scherer ^m, M. Gobert ^t, S. Saheb ^b, N. Fage ^m, J.-B. Ducloyer ^a, A. Rivet ⁿ, S. Beltran ^o, A.-M. Guennoc ^o, B. Audoin ^h, M.-A. Laville ^p, P. Branger ^p, R.K. Khanna ^o, C. Roth ^l, C. Bensa ^f, J. Bursztyn ^q, D. Biotti ^r, D. Laplaud ^a, B. Brochet ^c, S. Wiertlewski ^a, C. Froment ^s, P. Lebranchu ^a
^a Nantes University Hospital, Nantes, France
^b Paris University Hospital, La Pitié-Salpêtrière, Paris, France
^c Bordeaux University Hospital, Bordeaux, France
^d Paris University Hospital, Necker, Paris, France
^e Martinique University Hospital, Fort-de-France, Martinique, France
^f Paris University Hospital, Fondation Rothschild, Paris, France
^g Rennes University Hospital, Rennes, France
^h Marseille University Hospital, Marseille, France
ⁱ Strasbourg University Hospital, Strasbourg, France
^j Paris University Hospital, Quinze-Vingts, Paris, France
^k Lille University Hospital, Lille, France
^l Alpes Léman Hospital, Contamine-sur-Arve, France
^m Angers University Hospital, Angers, France
ⁿ Besançon University Hospital, Besançon, France
^o Tours University Hospital, Tours, France
^p Caen University Hospital, Caen, France
^q Paris University Hospital, Paris, France
^r Toulouse University Hospital, Toulouse, France
^s Lyon University Hospital, Lyon, France
^t Brest University Hospital, Brest, France

^⁎Corresponding author. Nantes University Hospital, 44000 Nantes, France.Nantes University HospitalNantes44000France

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Wednesday 16 July 2025
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Abstract

Introduction

Some patients remain severely disabled after an episode of optic neuritis. Several studies have shown that plasmapheresis (PE) can improve visual prognosis in the absence of satisfactory recovery after corticosteroids. However, there is no clear ophthalmological criterion for doing PE, and practices vary widely. The objective of the present study was to better define the rationales for use of PE.

Material and methods

We investigated the real-life indications for PE in French expert centers. Based on the responses to a questionnaire and the current literature, we further provided guidelines aiming to standardize the use of PE for the management of optic neuritis.

Results

Twenty expert centers completed the questionnaire. Together, they accounted for 90% of patients treated by PE in France during the study period. The main criteria for using PE were as follows: severely impaired visual acuity despite corticosteroids (mean visual acuity<0.6 logMAR or 20/80), high suspicion for neuromyelitis optica spectrum disorder, bilateral optic neuritis, or a profound visual field alteration.

Conclusion

This study provides insightful information about the real-life indications for PE in French centers for the treatment of optic neuritis. Based on our findings and the available data in the literature, we provide a decision-making algorithm for the management of optic neuritis.

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Keywords : Optic neuritis, Neuromyelitis optica, Multiple sclerosis, Plasmapheresis, Plasma exchange, Intravenous immunoglobulin

Plan

☆	Given her role as Associate Editor, the author Hélène Zephir had no involvement in the peer-review process of this article, nor did she have access to any information regarding this process. She did not participate in the decision-making regarding the article.