Contributions
Abstract: P674
Type: Poster
Abstract Category: Therapy - disease modifying - 26 Immunomodulation/Immunosuppression
Background: Neuromyelitis Optica Spectrum Disorders (NMOSD) have been considered a disease with poor outcomes and a high degree of morbidity and mortality in the past. We have been offering a proactive, early, standardised stepwise escalation protocol of immunosuppressive treatments for NMOSD for 10 years using commonly available and relatively inexpensive drugs, including corticosteroids, azathioprine, mycophenolate and rituximab.
Methods: We compared the annualised relapse rates (ARR) and expanded disability status scale (EDSS) scores of 130 NMOSD patients (95 AQP4-IgG positive, 12 MOG-IgG positive, 23 seronegative) seen in a specialist NMOSD clinic at first presentation to the clinic and at most recent follow-up.
Results: Median disease duration prior to attending clinic was 3.51 years and median follow-up in clinic was 3.68 years (0.33-10.11 years). At last follow up 39 patients (30%) are on treatment with azathioprine, 30 patients on mycophenolate mofetil (23%), 38 patients on rituximab (29%) and15 patients (12%) on other immunosuppressant medications; 8 patients (6%) are not on treatment. Median ARR was 0.97 (range 0.09-7.77) at presentation and 0 (0-1.65) on final follow-up (p < 0.0001). 62% of all patients (and 61% of AQP4-IgG positive patients) remained relapse-free at last follow-up. Median EDSS score was unchanged at 4.0, at presentation and at last follow-up, with 84% of patients either improving or maintaining their EDSS score. 4 patients (3%) died during follow-up and none of these deaths were directly caused by an NMOSD relapse.
Conclusion: Relapse outcomes of NMOSD have improved remarkably in the last few years using conventional immunosuppressants in a standardized manner in specialist care settings. However improvement in disability is limited, indicating the importance of early aggressive management of relapses and index events with high probability of NMOSD.
Disclosure:
D Whittam: Nothing to disclose. S Hamid: Nothing to disclose. S Linaker: Nothing to disclose. K Mutch: Nothing to disclose. A Jacob: Dr Jacob has received research grants from Biogen Idec and Alexion Pharmaceuticals and speakers fees from Biogen, Chugai, Sanofi-Genzyme and Terumo-BCT.
Abstract: P674
Type: Poster
Abstract Category: Therapy - disease modifying - 26 Immunomodulation/Immunosuppression
Background: Neuromyelitis Optica Spectrum Disorders (NMOSD) have been considered a disease with poor outcomes and a high degree of morbidity and mortality in the past. We have been offering a proactive, early, standardised stepwise escalation protocol of immunosuppressive treatments for NMOSD for 10 years using commonly available and relatively inexpensive drugs, including corticosteroids, azathioprine, mycophenolate and rituximab.
Methods: We compared the annualised relapse rates (ARR) and expanded disability status scale (EDSS) scores of 130 NMOSD patients (95 AQP4-IgG positive, 12 MOG-IgG positive, 23 seronegative) seen in a specialist NMOSD clinic at first presentation to the clinic and at most recent follow-up.
Results: Median disease duration prior to attending clinic was 3.51 years and median follow-up in clinic was 3.68 years (0.33-10.11 years). At last follow up 39 patients (30%) are on treatment with azathioprine, 30 patients on mycophenolate mofetil (23%), 38 patients on rituximab (29%) and15 patients (12%) on other immunosuppressant medications; 8 patients (6%) are not on treatment. Median ARR was 0.97 (range 0.09-7.77) at presentation and 0 (0-1.65) on final follow-up (p < 0.0001). 62% of all patients (and 61% of AQP4-IgG positive patients) remained relapse-free at last follow-up. Median EDSS score was unchanged at 4.0, at presentation and at last follow-up, with 84% of patients either improving or maintaining their EDSS score. 4 patients (3%) died during follow-up and none of these deaths were directly caused by an NMOSD relapse.
Conclusion: Relapse outcomes of NMOSD have improved remarkably in the last few years using conventional immunosuppressants in a standardized manner in specialist care settings. However improvement in disability is limited, indicating the importance of early aggressive management of relapses and index events with high probability of NMOSD.
Disclosure:
D Whittam: Nothing to disclose. S Hamid: Nothing to disclose. S Linaker: Nothing to disclose. K Mutch: Nothing to disclose. A Jacob: Dr Jacob has received research grants from Biogen Idec and Alexion Pharmaceuticals and speakers fees from Biogen, Chugai, Sanofi-Genzyme and Terumo-BCT.