TONE
What it found
The main measure did not show a significant benefit.
“Mean pRNFL atrophy was 15·93 μm (SD 14·91) in the erythropoietin group and 14·65 μm (15·60) in the placebo group (adjusted mean treatment difference 1·02 μm; 95% CI -5·51 to 7·55; p=0·76).”Read by software from the paper's abstract
week 26
| Group | n | Value |
|---|---|---|
| Erythropoietin | 52 | 15.93 μm (SD 14.91) |
| Placebo | 51 | 14.65 μm (15.60) |
adjusted mean treatment difference 1.02 μm (95% CI -5.51–7.55)
p = 0.76
Total participants: 108
Read by software from the paper's abstract
What was tested
Treatment tested
- Epoetin alfa
Erythropoietin receptor agonist
Placebo or sham
- Placebo
What it measured
Main measures
Global retinal nerve fibre layer thickness (RNFLT-G)
6 months
Retina scans (OCT)Low contrast visual acuity (LCVA)
6 months
Vision1) RNFLT-G-12 of contralateral healthy eye at baseline minus RNFLT-G-12 of the affected eye 6 months after randomisation
Other measures (12)
Absolute values of the global retinal nerve fibre layer thickness
6 months
Retina scans (OCT)Retinal nerve fibre layer thickness in the papillomacular bundle
6 months
Retina scans (OCT)Retinal nerve fibre layer thickness in the temporal quadrant
6 months
Retina scans (OCT)Total macular volume
6 months
Visual acuity
6 months
VisionContrast sensitivity
6 months
Mean visual field defect
6 months
Latency [ms] and amplitude [µV] of visual evoked potentials (VEP)
6 months
Myelin repairExpanded Disability Status Scale (EDSS) score
6 months
Disability progressionQuality of life
6 months
Quality of life (reported by participants)
Who could take part
Optic neuritis · 18 to 50
Patients eligible for inclusion in this trial must meet all of the following criteria: 1. Written informed consent obtained according to international guidelines and local laws 2. Male and female patients aged ≥ 18 to ≤ 50 years 3. Patients with ON 4. First symptoms of ON ≤ 10 days prior to the first administration of investigational product 5. High contrast visual acuity (HCVA) of ≤ 0.5 (decimal system) 6. Adequate OCT measurements available Patients eligible for this trial must not meet any of the following criteria: 1. Patient without legal capacity who is unable to understand the nature, significance and consequences of the trial 2. Simultaneous participation in another interventional trial which could interfere with this trial and/or participation in a clinical trial within the last 3 months before enrolment in this trial 3. Refractive anomalies: Hyperopia > 5 dpt, myopia \< -7 dpt, astigmatism > 3 dpt 4. Media opacity 5. Severe papillitis 6. Previous ON 7. Any other optic nerve and retinal disease 8. Pre-existing MS or any other neurological disease 9. Congenital diseases: * thrombophilia * phenylketonuria 10. Acquired diseases: * autoimmune diseases, * cardiovascular diseases, * diabetes mellitus, * uncontrolled hypertension (with blood pressure > 140 / 90 mm Hg (cf. chapter 7.7.5)), * any malignancy, * epilepsy, * known tuberculosis with ongoing or unknown activity, * acute gastrointestinal ulceration within the last 3 months prior to randomisation, * acute viral, bacterial or fungal infection, * known infection with Human Immunodeficiency Virus (HIV), Hepatitis B Virus, or Hepatitis C Virus, * history of colitis ulcerosa, diverticulitis, or acute enteroanastomosis, * known osteoporosis, * history of thromboembolic events, * elevated haemoglobin level (>17 g/dl in men or >15 g/dl in women) * polycythaemia * any other significant illness potentially interfering with any trial assessment or trial treatment 11. Performing semi-professional or professional sporting activities or physical training 12. Pre-treatment with corticosteroids in the last 30 days prior to the onset of optic neuritis 13. Pre-treatment with EPO 14. Known or persistent abuse of medication, drugs or alcohol 15. Active immunization within 2 weeks prior to randomisation 16. Significant surgery within 4 weeks prior to randomisation 17. Blood donation or bloodletting within 4 weeks prior to screening 18. Pre-treatment with immunosuppressive or immunomodulatory agents 19. Persons who are in a relationship of dependence/employment with the sponsor or the investigator This section concerns only female patients who are able to have a child: 20. Current or planned pregnancy; nursing period within 3 months from investigational product administration 21. Unwillingness to use one of the following safe combination methods of contraception within 3 months from investigational product administration to achieve a PEARL index of \<1: female condom, diaphragm or coil, each used in combination with a spermicide; hormonal intra-uterine device or hormonal contraception in combination with a mechanical method of contraception
As registered. Criteria can change, so ask the trial team or your neurologist.
About this trial
In the sponsor's words
This clinical trial aims at preventing visual dysfunction and optic nerve degeneration associated with autoimmune optic neuritis by systemic i.v. administration of 33.000 IU erythropoietin over 3 days. The primary objective is to determine the efficacy of erythropoietin compared to placebo given as add-on to methylprednisolone as assessed by measurements of retinal nerve fibre layer thickness and low contrast visual acuity 6 months after acute optic neuritis.
Papers
Results
Clinical Predictors in Acute Optic Neuritis: Analysis Based on Clinical Trial Data.Ophthalmology · 2025
Results
Disease Course of Clinically Isolated Optic Neuritis.Neurol Neuroimmunol Neuroinflamm · 2024
Results
Safety and efficacy of erythropoietin for the treatment of patients with optic neuritis (TONE): a randomised, double-blind, multicentre, placebo-controlled study.Lancet Neurol · 2021
Mean pRNFL atrophy was 15·93 μm (SD 14·91) in the erythropoietin group and 14·65 μm (15·60) in the placebo group (adjusted mean treatment difference 1·02 μm; 95% CI -5·51 to 7·55; p=0·76).
Read by software from the paper's abstract
Results
Disease Activity and Conversion into Multiple Sclerosis after Optic Neuritis Is Treated with Erythropoietin.Int J Mol Sci · 2016
Results
Treatment of optic neuritis with erythropoietin (TONE): a randomised, double-blind, placebo-controlled trial-study protocol.BMJ Open · 2016
Results
[New aspects in the therapy of multiple sclerosis and optic neuritis].Ophthalmologe · 2014
Results
Kuchlin S, Ihorst G, Grotejohann B, Beisse F, Heinrich SP, Albrecht P, Ungewiss J, Worner M, Hug MJ, Wolf S, Diem R, Lagreze WA; TONE Study Group. Treatment With Erythropoietin for Patients With Optic Neuritis: Long-term Follow-up. Neurol Neuroimmunol Neuroinflamm. 2023 Apr 24;10(4):e200067. doi: 10.1212/NXI.0000000000200067. Print 2023 Jul.Results
Wilhelm H, Schabet M. The Diagnosis and Treatment of Optic Neuritis. Dtsch Arztebl Int. 2015 Sep 11;112(37):616-25; quiz 626. doi: 10.3238/arztebl.2015.0616.Background
Suhs KW, Hein K, Sattler MB, Gorlitz A, Ciupka C, Scholz K, Kasmann-Kellner B, Papanagiotou P, Schaffler N, Restemeyer C, Bittersohl D, Hassenstein A, Seitz B, Reith W, Fassbender K, Hilgers R, Heesen C, Bahr M, Diem R. A randomized, double-blind, phase 2 study of erythropoietin in optic neuritis. Ann Neurol. 2012 Aug;72(2):199-210. doi: 10.1002/ana.23573.
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History
Started
Nov 2014
Main results due
Jun 2018
Finished
Nov 2019
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