Trends in optic neuritis incidence and prevalence in the UK and association with systemic and neurologic disease

Tasanee Braithwaite, Anuradhaa Subramanian, Axel Petzold , James Galloway, Nicola Adderley, Susan Mollan, Gordon T. Plant , Krishnarajah Nirantharakumar, Alastair Denniston

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Importance Epidemiologic data on optic neuritis (ON) incidence and associations with immune-mediated inflammatory diseases (IMIDs) are sparse.

Objective To estimate 22-year trends in ON prevalence and incidence and association with IMIDs in the United Kingdom.

Design, Setting, and Participants This cohort study analyzed data from The Health Improvement Network from January 1, 1995, to September 1, 2019. The study included 10 937 511 patients 1 year or older with 75.2 million person-years’ follow-up. Annual ON incidence rates were estimated yearly (January 1, 1997, to December 31, 2018), and annual ON prevalence was estimated by performing sequential cross-sectional studies on data collected on January 1 each year for the same period. Data for 1995, 1996, and 2019 were excluded as incomplete. Risk factors for ON were explored in a cohort analysis from January 1, 1997, to December 31, 2018. Matched case-control and retrospective cohort studies were performed using data from January 1, 1995, to September 1, 2019, to explore the odds of antecedent diagnosis and hazard of incident diagnosis of 66 IMIDs in patients compared with controls.

Exposures Optic neuritis.

Main Outcomes and Measures Annual point prevalence and incidence rates of ON, adjusted incident rate ratios (IRRs) for risk factors, and adjusted odds ratios (ORs) and adjusted hazard ratios (HRs) for 66 IMIDs.

Results A total of 10 937 511 patients (median [IQR] age at cohort entry, 32.6 [18.0-50.4] years; 5 571 282 [50.9%] female) were studied. A total of 1962 of 2826 patients (69.4%) with incident ON were female and 1192 of 1290 92.4%) were White, with a mean (SD) age of 35.6 (15.6) years. Overall incidence across 22 years was stable at 3.7 (95% CI, 3.6-3.9) per 100 000 person-years. Annual point prevalence (per 100 000 population) increased with database maturity, from 69.3 (95% CI, 57.2-81.3) in 1997 to 114.8 (95% CI, 111.0-118.6) in 2018. The highest risk of incident ON was associated with female sex, obesity, reproductive age, smoking, and residence at higher latitude, with significantly lower risk in South Asian or mixed race/ethnicity compared with White people. Patients with ON had significantly higher odds of prior multiple sclerosis (MS) (OR, 98.22; 95% CI, 65.40-147.52), syphilis (OR, 5.76; 95% CI, 1.39-23.96), Mycoplasma (OR, 3.90; 95% CI, 1.09-13.93), vasculitis (OR, 3.70; 95% CI, 1.68-8.15), sarcoidosis (OR, 2.50; 95% CI, 1.21-5.18), Epstein-Barr virus (OR, 2.29; 95% CI, 1.80-2.92), Crohn disease (OR, 1.97; 95% CI, 1.13-3.43), and psoriasis (OR, 1.28; 95% CI, 1.03-1.58). Patients with ON had a significantly higher hazard of incident MS (HR, 284.97; 95% CI, 167.85-483.81), Behçet disease (HR, 17.39; 95% CI, 1.55-195.53), sarcoidosis (HR, 14.80; 95% CI, 4.86-45.08), vasculitis (HR, 4.89; 95% CI, 1.82-13.10), Sjögren syndrome (HR, 3.48; 95% CI, 1.38-8.76), and herpetic infection (HR, 1.68; 95% CI, 1.24-2.28).

Conclusions and Relevance The UK incidence of ON is stable. Even though predominantly associated with MS, ON has numerous other associations with IMIDs. Although individually rare, together these associations outnumber MS-associated ON and typically require urgent management to preserve sight.
Original languageEnglish
Pages (from-to)1514-1523
Number of pages10
JournalJAMA Neurology
Issue number12
Publication statusPublished - 5 Oct 2020

Bibliographical note

Funding Information:
reported receiving salary support from the patient charity Olivia’s Vision. Dr Galloway reported receiving personal fees from AbbVie, BMS, Gilead, Janssen, Eli Lilly and Co, Novartis, Pfizer, Roche, Sanofi, and UCB outside the submitted work. Dr Mollan reported receiving personal fees from Allergan, Chugai Pharma UK Ltd, Invex Therapeutics, Heidelberg Engineering, Neurodiem, Novartis, Santhera, Santen, and Roche outside the submitted work. Dr Nirantharakumar reported receiving grants from Medical Research Council, National Institute for Health Research, AstraZeneca, MSD, Boehringer Ingelheim, Vifor, and Health Data Research UK and personal fees from Sanofi outside the submitted work. Drs Denniston reported receiving grant support from Health Data Research UK. No other disclosures were reported.

Publisher Copyright:
© 2020 American Medical Association. All rights reserved.

Copyright 2020 Elsevier B.V., All rights reserved.

ASJC Scopus subject areas

  • Clinical Neurology


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