(B-120) Optic Neuritis and Corticosteroid Utilization among Patients with Multiple Sclerosis: An Electronic Medical Records Study

Background: Optic neuritis (ON) involves inflammation of the optic nerve that often leads to acute visual loss and painful eye movement. Nearly 50% of all multiple sclerosis (MS) patients have ON during their disease course. Intravenous corticosteroids are commonly used to accelerate visual recovery and potentially reduce the risk of ON recurrence and MS progression. However, there is a significant gap in the literature regarding the prevalence of ON and the extent of corticosteroid use among MS patients in the United States.

Objectives: To evaluate ON prevalence among MS patients and examine the predictors of corticosteroid use for ON management.

Methods: This retrospective observational study utilized TriNetX electronic medical record data to evaluate trends in ON diagnosis and ON-related corticosteroid use among MS patients from 2009 to 2019. Descriptive analyses were used to assess the annual trends of ON diagnosis, further stratified by demographic variables. Any methylprednisolone used within 7 days after an ON-diagnosis visit was considered. A generalized estimating equation (GEE) model with robust variance estimation was used to evaluate the association between patients' 12-month baseline demographic and clinical characteristics and corticosteroid use, accounting for within-subject correlation at the event level.

Results: The overall prevalence of ON among MS patients was 4.9% during the study period. Most MS patients with ON were aged 34–50 years (41.5%), predominantly female (77.6%), and white (79.1%). Among 36,743 ON-related visits, 10.5% of patients received corticosteroids within seven days of diagnosis. The multivariable GEE model found that younger patients had higher odds of corticosteroid use compared to those aged ≥50 years ( < 34 years: adjusted odds ratio [aOR]: 2.68, 95% CI: 2.17-3.30 and 34-50 years: aOR: 1.80, 95% CI: 1.47-2.20). Female patients were less likely to receive corticosteroids (aOR: 0.77, 95% CI: 0.64-0.92). African American patients (aOR: 1.60, 95% CI: 1.32-1.94) and Hispanic patients (aOR: 1.62, 95% CI: 1.16-2.28) have a higher likelihood of being prescribed corticosteroids. However, patients receiving disease-modifying therapies (aOR: 0.65, 95% CI: 0.54-0.79), those with more Elixhauser comorbidities, and those with fatigue symptoms (aOR 0.78, 95% CI: 0.64-0.94) were less likely to be prescribed corticosteroids.

Conclusions: The study found that nearly 1 in 20 patients with MS have ON. Approximately 1 in 10 patient visits for ON involved corticosteroid prescription during the one-week follow-up period. Both demographic and clinical factors influenced corticosteroid prescribing. Given the increase in MS, further evaluation of corticosteroid use and its impact on treatment outcomes is needed to optimize vision care in MS.