Adding erythropoietin to intravenous methylprednisolone in acute treatment of attacks of neuromyelitis optica spectrum disorders:  A randomized controlled trial

Maryam Shafaei; Fereshteh Ghadiri; Amirreza Azimi; Abdorreza Naser Moghadasi; Mahdi Hakiminezhad; Mohammad Ali Sahraian

doi:10.18502/cjn.v21i4.11715

Maryam Shafaei Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
Fereshteh Ghadiri Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
Amirreza Azimi Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
Abdorreza Naser Moghadasi Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
Mahdi Hakiminezhad Department of Colorectal Surgery, School of Medicine, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
Mohammad Ali Sahraian Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran

DOI: https://doi.org/10.18502/cjn.v21i4.11715

Keywords: Neuromyelitis Optica; Erythropoietin; Methylprednisolone; Optic Neuritis; Myelitis

Abstract

Background: Neuromyelitis optica spectrum disorder (NMOSD) is an autoimmune disease of the central nervous system (CNS) that prompts immediate potent treatment. Delaying treatment could leave debilitating sequelae. As erythropoietin (EPO) has shown neuroprotective effects, we studied the effects of adding EPO to intravenous methylprednisolone (IVMP) in patients with acute attacks of NMOSD.

Methods: NMOSD cases with acute attacks were included. Cases of optic neuritis (ON) and those with myelitis were separated. After randomization [with block sizes of 2 (1:1 ratio)], the patients in the intervention group received IVMP 1000 mg/day and intravenous (IV) EPO 20000 U/day for five days. IVMP 1000 mg/day and normal saline (NS) were administered in the control group. Staged eye score and motor forces were evaluated in the patients with ON and myelitis, respectively, at the time of the attack and three months later. Primary patient allocation and clinical assessments were blinded to the physicians.

Results: Mean age of participants was 53.87 ± 11.53 years. At follow-up, in the ON arm, the median improvement in staged eye score was 2 in the control and 5 in the intervention group. The difference was significant (P < 0.001). In the myelitis group, none of the patients in the control group had improvement in motor forces. All the patients in the intervention group showed substantial improvement with minimal or no remaining weakness. The difference was statistically significant (P = 0.029).

Conclusion: The results show the possible benefit of adding EPO to the classic IVMP in attacks of NMOSD
in both visual and motor aspects.