Contributions
Abstract: P305
Type: Poster
Abstract Category: Clinical aspects of MS - 2 MS Variants
Background: Neuromyelitis optica (NMO) remains a diagnostic and therapeutical challenge for neurologists, especially when considering the restriction for medication access and antibody testing in many countries.
Goals: To present an update on our observational series (Bichuetti. Mult Scler 2009), including treatment analysis.
Methods: Single centre prospective observational cohort with retrospective analysis.
Results: we reviewed 1.748 medical records of patients followed from 1995 to December 31st, 2015. From 216 with possible NMO, 37 were excluded due to irretrievable information and 21 due to non-NMO diagnosis; 158 patients were included: 8 with monophasic NMO (mNMO) and 150 with relapsing NMO (rNMO). Mean age of onset was 33.6 for mNMO and 33.0 for rNMO, with median 8.3 years of disease duration for mNMO and 7.0 for rNMO; half of them were Afro-descendants in both groups. Both groups presented brain MRI abnormalities: 25% in mNMO and 48,7% in rNMO. 54% of the rNMO were anti-AQP4 positive and 82.7% fulfilled 2015 diagnostic criteria; all the mNMO were anti-AQP 4 negative. One patient had concomitant autoimmune disease in the mNMO and 29 in the rNMO group. Six patients have deceased during follow-up, all from the relapsing cohort. 74.7% of the rNMO group presented the complete NMO syndrome (with 2 of the core symptoms: optic neuritis, longitudinal extensive transverse myelitis and/or area postrema syndrome), 10.7% relapsing myelitis and 14.7% relapsing optic neuritis. All patients in the rNMO group received at least one preventive treatment, including disease modifying therapies for multiple sclerosis (16), prednisone (101), azathioprine (100), mycophenolate (4), cyclosporine (2), methotrexate (20), cyclophosphamide (16), rituximab (2) or IV immunoglobulin (8). 70% of the treated rNMO presented an EDSS variation of 0 to 0.5, 12.7% 1.0 to 1.5, 6% 2.0 to 2.5, 4.7% 3.0 to 3.5 and 6.7% ³4.0.
Conclusion: 82.7% of patients treated with oral immunosuppressant, most of them azathioprine and methotrexate with or without prednisone, remained stable or with minimal EDSS variation during 8 years of follow-up. Early diagnosis and treatment implementation might contribute to this result that is important for those practicing in countries with restricted access to monoclonal antibodies.
Disclosure:
Denis Bernardi Bichuetti has received speaking/consulting honoraria from Bayer Health Care, Biogen Idec, Merck Serono, Genzyme-Sanofi, TEVA and Roche and had travel expenses to scientific meetings sponsored by Bayer Health Care, Merck Serono, TEVA and Roche.
Marília Mamprim de Moraes has has been awarded an educational grant by Bayer Health Care to study for an online Masters in Neuorimmunologiy at Universitat Autònoma de Barcelona (UAB), has received speaking honoraria from Novartis and financial assistance to attend neurology congress paid by Bayer Health Care, Merck Serono and TEVA.
Nilton Amorim de Souza has nothing to disclose
Enedina Maria Lobato de Oliveira has received speaker fee from Teva, Biogen, Genzyme
Abstract: P305
Type: Poster
Abstract Category: Clinical aspects of MS - 2 MS Variants
Background: Neuromyelitis optica (NMO) remains a diagnostic and therapeutical challenge for neurologists, especially when considering the restriction for medication access and antibody testing in many countries.
Goals: To present an update on our observational series (Bichuetti. Mult Scler 2009), including treatment analysis.
Methods: Single centre prospective observational cohort with retrospective analysis.
Results: we reviewed 1.748 medical records of patients followed from 1995 to December 31st, 2015. From 216 with possible NMO, 37 were excluded due to irretrievable information and 21 due to non-NMO diagnosis; 158 patients were included: 8 with monophasic NMO (mNMO) and 150 with relapsing NMO (rNMO). Mean age of onset was 33.6 for mNMO and 33.0 for rNMO, with median 8.3 years of disease duration for mNMO and 7.0 for rNMO; half of them were Afro-descendants in both groups. Both groups presented brain MRI abnormalities: 25% in mNMO and 48,7% in rNMO. 54% of the rNMO were anti-AQP4 positive and 82.7% fulfilled 2015 diagnostic criteria; all the mNMO were anti-AQP 4 negative. One patient had concomitant autoimmune disease in the mNMO and 29 in the rNMO group. Six patients have deceased during follow-up, all from the relapsing cohort. 74.7% of the rNMO group presented the complete NMO syndrome (with 2 of the core symptoms: optic neuritis, longitudinal extensive transverse myelitis and/or area postrema syndrome), 10.7% relapsing myelitis and 14.7% relapsing optic neuritis. All patients in the rNMO group received at least one preventive treatment, including disease modifying therapies for multiple sclerosis (16), prednisone (101), azathioprine (100), mycophenolate (4), cyclosporine (2), methotrexate (20), cyclophosphamide (16), rituximab (2) or IV immunoglobulin (8). 70% of the treated rNMO presented an EDSS variation of 0 to 0.5, 12.7% 1.0 to 1.5, 6% 2.0 to 2.5, 4.7% 3.0 to 3.5 and 6.7% ³4.0.
Conclusion: 82.7% of patients treated with oral immunosuppressant, most of them azathioprine and methotrexate with or without prednisone, remained stable or with minimal EDSS variation during 8 years of follow-up. Early diagnosis and treatment implementation might contribute to this result that is important for those practicing in countries with restricted access to monoclonal antibodies.
Disclosure:
Denis Bernardi Bichuetti has received speaking/consulting honoraria from Bayer Health Care, Biogen Idec, Merck Serono, Genzyme-Sanofi, TEVA and Roche and had travel expenses to scientific meetings sponsored by Bayer Health Care, Merck Serono, TEVA and Roche.
Marília Mamprim de Moraes has has been awarded an educational grant by Bayer Health Care to study for an online Masters in Neuorimmunologiy at Universitat Autònoma de Barcelona (UAB), has received speaking honoraria from Novartis and financial assistance to attend neurology congress paid by Bayer Health Care, Merck Serono and TEVA.
Nilton Amorim de Souza has nothing to disclose
Enedina Maria Lobato de Oliveira has received speaker fee from Teva, Biogen, Genzyme