Contributions
Abstract: 106
Type: Oral
Abstract Category: Clinical aspects of MS - MS Variants
Background: Attacks of neuromyelitis optica spectrum disorder (NMOSD) are frequent and often leave a residual deficit. While high-dose corticosteroids are recommended for first-line therapy of NMOSD attacks, apheresis therapies are often used for escalation. We recently showed that apheresis therapies might be superior to high-dose corticosteroids in the first-line therapy of NMOSD myelitis.
Objective: To analyse whether plasma exchange (PE) and immunoadsorption (IA) are of equivalent efficacy in NMOSD attacks and to identify predictive factors for complete remission after apheresis therapies.
Methods: We did a retrospective review of patient records from the NEMOS registry to assess demographic and diagnostic data, attack characteristics, therapies, and the short-term remission status (complete, CR; partial, PR; no remission, NR). Inclusion criteria were NMO according to Wingerchuk"s 2006 criteria or aquaporin-4-antibody (AQP4-ab)-positive NMOSD. Predictors of CR were analysed using multivariate generalized estimating equations (GEE) with important clinical parameters as covariates.
Results: We evaluated 871 NMOSD attacks in 185 patients (142 NMO, 43 NMOSD, 82% female). 207 attacks in 105 patients were treated with apheresis therapies, 192 with PE and 38 with IA (18 with multiple apheresis therapies). Apheresis therapies were used for first-line therapy in 72 attacks, second-line in 98 attacks, and third-line or later in 37 attacks. PE and IA did not differ in terms of distribution among treatments courses (p=0.303, exact Chi2-test) and clinical attack manifestation (p=0.055, exact Chi2-test), although IA tended to be used more often for isolated optic neuritis. As a first-line therapy, PE (n=62) induced CR in 30.6%, PR in 51.6% and NR in 17.8% of attacks. IA (n=9) induced CR in 11.1% and PR in 88.9% of attacks. As second-line therapy after high dose corticosteroids, PE (n=74) induced CR in 4.1%, PR in 87.8% and NR in 8.1% and IA (n=17) PR in 100% of attacks. Independent predictors of CR in multivariate analysis were first- vs. second-line treatment (OR=14.37, p=0.033), AQP4-ab positivity (OR=38.75, p=0.019) and time from attack onset to start of therapy (OR=0.94, p=0.004). There was a trend to predict CR for younger age (p=0.051), absence of simultaneous optic neuritis and myelitis (p=0.055), and PE vs. IA (p=0.062).
Conclusion: PE and IA are both effective to reduce NMOSD attacks. The early use is recommended and further prospective studies are needed.
Disclosure:
IK has received honoraria for consultancy or lectures and travel reimbursement from Bayer Health Care, Biogen Idec, Chugai, Novartis, and Roche and grant support from Biogen Idec, Novartis, Chugai and Diamed.
AG, NB, KF, and KW have nothing to disclose.
CT has received honoraria for consultation and expert testimony from Bayer Vital GmbH, Biogen Idec/Biogen GmbH, Genzyme GmbH, Novartis Pharmaceuticals/Pharma GmbH, Sanofi Aventis Deutschland GmbH.
Abstract: 106
Type: Oral
Abstract Category: Clinical aspects of MS - MS Variants
Background: Attacks of neuromyelitis optica spectrum disorder (NMOSD) are frequent and often leave a residual deficit. While high-dose corticosteroids are recommended for first-line therapy of NMOSD attacks, apheresis therapies are often used for escalation. We recently showed that apheresis therapies might be superior to high-dose corticosteroids in the first-line therapy of NMOSD myelitis.
Objective: To analyse whether plasma exchange (PE) and immunoadsorption (IA) are of equivalent efficacy in NMOSD attacks and to identify predictive factors for complete remission after apheresis therapies.
Methods: We did a retrospective review of patient records from the NEMOS registry to assess demographic and diagnostic data, attack characteristics, therapies, and the short-term remission status (complete, CR; partial, PR; no remission, NR). Inclusion criteria were NMO according to Wingerchuk"s 2006 criteria or aquaporin-4-antibody (AQP4-ab)-positive NMOSD. Predictors of CR were analysed using multivariate generalized estimating equations (GEE) with important clinical parameters as covariates.
Results: We evaluated 871 NMOSD attacks in 185 patients (142 NMO, 43 NMOSD, 82% female). 207 attacks in 105 patients were treated with apheresis therapies, 192 with PE and 38 with IA (18 with multiple apheresis therapies). Apheresis therapies were used for first-line therapy in 72 attacks, second-line in 98 attacks, and third-line or later in 37 attacks. PE and IA did not differ in terms of distribution among treatments courses (p=0.303, exact Chi2-test) and clinical attack manifestation (p=0.055, exact Chi2-test), although IA tended to be used more often for isolated optic neuritis. As a first-line therapy, PE (n=62) induced CR in 30.6%, PR in 51.6% and NR in 17.8% of attacks. IA (n=9) induced CR in 11.1% and PR in 88.9% of attacks. As second-line therapy after high dose corticosteroids, PE (n=74) induced CR in 4.1%, PR in 87.8% and NR in 8.1% and IA (n=17) PR in 100% of attacks. Independent predictors of CR in multivariate analysis were first- vs. second-line treatment (OR=14.37, p=0.033), AQP4-ab positivity (OR=38.75, p=0.019) and time from attack onset to start of therapy (OR=0.94, p=0.004). There was a trend to predict CR for younger age (p=0.051), absence of simultaneous optic neuritis and myelitis (p=0.055), and PE vs. IA (p=0.062).
Conclusion: PE and IA are both effective to reduce NMOSD attacks. The early use is recommended and further prospective studies are needed.
Disclosure:
IK has received honoraria for consultancy or lectures and travel reimbursement from Bayer Health Care, Biogen Idec, Chugai, Novartis, and Roche and grant support from Biogen Idec, Novartis, Chugai and Diamed.
AG, NB, KF, and KW have nothing to disclose.
CT has received honoraria for consultation and expert testimony from Bayer Vital GmbH, Biogen Idec/Biogen GmbH, Genzyme GmbH, Novartis Pharmaceuticals/Pharma GmbH, Sanofi Aventis Deutschland GmbH.