Gabrielle Macaron, MD

"The escalation approach is becoming less and less popular over time, especially in recent years, and the early high efficacy approach is gaining more popularity, because we know the consequences long term in multiple sclerosis (MS). I'm hoping we can do the same in neuromyelitis optica spectrum disorders (NMOSD).”

Researchers from Cleveland Clinic have found that patients with an age of onset (AO) of under 21 years of NMOSD were 

more likely to experience severe residual visual loss

These patients were more likely to have SRVL, as well as blindness, binocular optic neuritis (ON), and recurrent optic neuritis when compared to patients with AO greater than or equal to 21 years. However, they were less likely to receive high-efficacy first-line oral therapy. After adjusting for race, sex and disease disruption, the odds of SRVL were 4.68 times greater in patients with an AO <21 years (95% CI, 1.53–14.34; 

 reached out to first author Gabrielle Macaron, MD, neurologist, Cleveland Clinic and Hôtel-Dieu de France Hospital, Lebanon, to learn more about NMOSD about the associations between NMOSD AO and vision loss. Macaron stressed that more research needs to be done to understand the differences between NMOSD in younger and older populations and that traditional approaches to treating NMOSD should shift according to these and previously reported data. She also discussed recent medications such as eculizumab being studied in NMOSD.

Macaron G, Khoury J, Bena J, et al. Early age of onset predicts severity of visual impairment in patients with neuromyelitis optica spectrum disorder. 

 Published online January 6, 2021. doi: 10.1177/1352458520981736

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The neurologist from Cleveland Clinic discussed how her study reinforced previous findings that individuals with early onset neuromyelitis optica spectrum disorders are more likely to experience severe vision loss. 

Investigating Disability and Onset Age in NMOSD: Gabrielle Macaron, MD

“Younger individuals have worse visual outcomes... for this reason, maybe we should treat them with the efficacious medications early on in the disease course. We need more data to make sure that higher efficacy meds are safe in this population. We should start thinking about treating those patients more actively and early on, without using an escalation approach, which is what we traditionally do in multiple sclerosis.”

 suggest that patients with an age of onset (AO) of under 21 years with neuromyelitis spectrum disorders (NMOSD) were more likely to experiences severe residual visual loss (SRVL) independent of disease duration.

First author Gabrielle Macaron, MD, neurologist, Cleveland Clinic and Hôtel-Dieu de France Hospital, Lebanon, and colleagues found that patients with an AO of under 21 years of age were more likely to have SRVL, as well as blindness, binocular optic neuritis (ON), and recurrent optic neuritis when compared to patients with AO ≥21 years. These patients were also more likely to receive less effective first-line oral therapy. The odds of SRVL were 4.68 times greater in patients with an AO <21 years (95% CI, 1.53–14.34; 

 = .007) after adjusting for race, sex and disease disruption.

 reached out to Macaron to learn more about NMOSD and its available therapies. She discussed what steps should be taken next to help reduce debilitating attacks of NMOSD in younger patients.

The neurologist from Cleveland Clinic discussed how her team found that patients with AO ≤21 years old had worse visual outcomes than those >21 years old. 

Gabrielle Macaron, MD

Articles

Investigating Disability and Onset Age in NMOSD: Gabrielle Macaron, MD

Improving Outcomes in Patients With Early Onset NMOSD: Gabrielle Macaron, MD