Contributions
Abstract: P848
Type: Poster
Abstract Category: Clinical aspects of MS - 2 MS Variants
Background: Neuromyelitis optica (NMO) is widely believed to be a devastating disease with a poor prognosis. Recently, new diagnostic criteria (2015) have formally expanded NMO spectrum disorders (NMOSD) roughly doubling the number of recognized cases. No study evaluated survival in NMOSD patients diagnosed according to the latest criteria.
Material and methods: We analyzed survival in patients from the Belgrade NMOSD cohort (Clinic of Neurology, Clinical Centre of Serbia) who meet the 2015 NMOSD diagnostic criteria. The demographic (age, gender, ethnicity), clinical (onset and each relapse characteristics, treatment course, autoimmune comorbidities), and paraclinical data (first performed: routine cerebrospinal fluid findings, serum anti-aquaporin 4 (AQP4), other autoantibodies, brain and spinal cord magnetic resonance imaging findings) were evaluated as potential predictors of survival. Serum AQP4-IgG antibodies were tested using transfected cell-based indirect immunofluorescence (Euroimmun AG). The patients were followed from disease onset up to the cut-off date (March 31, 2017 for survivors, the time of death for non-survivors). We analyzed survival probability using the Kaplan-Meier procedure and the predictive value of variables by univariate and multivariate Cox proportional hazard regression models.
Results: The Belgrade NMOSD cohort comprises 74 patients (female/male ratio, 5.7:1; median age, 49.9 years (range, 10.0-76.0 years)), followed for a median of 6.9 years (range, 6 months - 34.5 years). Median age at the disease onset was 40.0 years and median time from onset to maintenance treatment was 2.3 years. Serum AQP4-IgG antibodies were positive in 89.2% of patients. Seven patients (9.5%) died during the follow-up (NMOSD-related respiratory failure, n=4; sepsis, n=1; myocardial infarction, n=1; accidental death, n=1). Probabilities of survival after 5, 10, 15 and 20 years of disease were: 98.6%, 94.6%, 82.7% and 63.0%, respectively. Early predictors of longer survival in the univariate model were young age at onset (HR= 1.133; 95% CI, 1.033- 1.242; p= 0.008), a shorter time from onset to maintenance treatment (HR= 0.951; 95% CI, 0.951-0.995; p= 0.018) and area postrema symptoms at onset (HR= 0.107; 95% CI, 0.014-0.803; p=0.030).
Conclusions: Our results further support the need for an early treatment intervention in NMOSD. Such an approach could prolong survival in NMOSD.
Disclosure:
Irena Dujmović Basuroski received lecture fees and/or travel grants from Merck Serono, Bayer, Medis, Roche, Teva and Boehringer Ingelheim, received honoraria for acting as an advisor for Bayer and was supported by the Ministry of Education, Science and Technological Development of the Republic of Serbia (Grant No 175031).
Vanja Martinović has nothing to disclose.
Gorica Maric has received research grant support from the Ministry of Education and Science, Republic of Serbia (projects no. 175087 and 175090).
Sarlota Mesaros received speaker´s honoraria for Merck Serono and Novartis, travel grants from Bayer, Medis and Genzyme, a Sanofi Company, and was supported by the Ministry of Education, Science and Technological Development of the Republic of Serbia (Grant No 175031).
Tatjana Pekmezovic has received compensation for consulting services, travel expenses for scientific meetings, and speaking honoraria from Bayer Schering Pharma, Merck Serono, Actavis/Teva, Roche, Gedeon Richter, Novartis; supported by a grant of the Ministry of Education, Science and Technological Development, Republic of Serbia (No. 175087 and 175090).
Brian Weinshenker receives royalties from RSR Ltd, Oxford University, Hospices Civil de Lyon, and MVZ Labor PD Dr. Volkmann und Kollegen GbR for a patent of NMO-IgG as a diagnostic test for NMO and related disorders. He serves as a member of an adjudication committee for clinical trials in NMO being conducted by MedImmune and Alexion pharmaceutical companies. He is a consultant for Caladrius Biosciences regarding a clinical trial for NMO. He serves as a member of a data safety monitoring committee for clinical trials conducted by Novartis.
Jelena Drulovic serves on scientific advisory boards for Bayer Schering Pharma, Merck Serono, Teva, Genzyme, a Sanofi Company, Roche, and received honoraria for speaking from Merck Serono, Teva, Bayer Schering, Genzyme, a Sanofi Company, Medis; and has also received research grant support from the Ministry of Education and Science, Republic of Serbia (project no. 175031).
Abstract: P848
Type: Poster
Abstract Category: Clinical aspects of MS - 2 MS Variants
Background: Neuromyelitis optica (NMO) is widely believed to be a devastating disease with a poor prognosis. Recently, new diagnostic criteria (2015) have formally expanded NMO spectrum disorders (NMOSD) roughly doubling the number of recognized cases. No study evaluated survival in NMOSD patients diagnosed according to the latest criteria.
Material and methods: We analyzed survival in patients from the Belgrade NMOSD cohort (Clinic of Neurology, Clinical Centre of Serbia) who meet the 2015 NMOSD diagnostic criteria. The demographic (age, gender, ethnicity), clinical (onset and each relapse characteristics, treatment course, autoimmune comorbidities), and paraclinical data (first performed: routine cerebrospinal fluid findings, serum anti-aquaporin 4 (AQP4), other autoantibodies, brain and spinal cord magnetic resonance imaging findings) were evaluated as potential predictors of survival. Serum AQP4-IgG antibodies were tested using transfected cell-based indirect immunofluorescence (Euroimmun AG). The patients were followed from disease onset up to the cut-off date (March 31, 2017 for survivors, the time of death for non-survivors). We analyzed survival probability using the Kaplan-Meier procedure and the predictive value of variables by univariate and multivariate Cox proportional hazard regression models.
Results: The Belgrade NMOSD cohort comprises 74 patients (female/male ratio, 5.7:1; median age, 49.9 years (range, 10.0-76.0 years)), followed for a median of 6.9 years (range, 6 months - 34.5 years). Median age at the disease onset was 40.0 years and median time from onset to maintenance treatment was 2.3 years. Serum AQP4-IgG antibodies were positive in 89.2% of patients. Seven patients (9.5%) died during the follow-up (NMOSD-related respiratory failure, n=4; sepsis, n=1; myocardial infarction, n=1; accidental death, n=1). Probabilities of survival after 5, 10, 15 and 20 years of disease were: 98.6%, 94.6%, 82.7% and 63.0%, respectively. Early predictors of longer survival in the univariate model were young age at onset (HR= 1.133; 95% CI, 1.033- 1.242; p= 0.008), a shorter time from onset to maintenance treatment (HR= 0.951; 95% CI, 0.951-0.995; p= 0.018) and area postrema symptoms at onset (HR= 0.107; 95% CI, 0.014-0.803; p=0.030).
Conclusions: Our results further support the need for an early treatment intervention in NMOSD. Such an approach could prolong survival in NMOSD.
Disclosure:
Irena Dujmović Basuroski received lecture fees and/or travel grants from Merck Serono, Bayer, Medis, Roche, Teva and Boehringer Ingelheim, received honoraria for acting as an advisor for Bayer and was supported by the Ministry of Education, Science and Technological Development of the Republic of Serbia (Grant No 175031).
Vanja Martinović has nothing to disclose.
Gorica Maric has received research grant support from the Ministry of Education and Science, Republic of Serbia (projects no. 175087 and 175090).
Sarlota Mesaros received speaker´s honoraria for Merck Serono and Novartis, travel grants from Bayer, Medis and Genzyme, a Sanofi Company, and was supported by the Ministry of Education, Science and Technological Development of the Republic of Serbia (Grant No 175031).
Tatjana Pekmezovic has received compensation for consulting services, travel expenses for scientific meetings, and speaking honoraria from Bayer Schering Pharma, Merck Serono, Actavis/Teva, Roche, Gedeon Richter, Novartis; supported by a grant of the Ministry of Education, Science and Technological Development, Republic of Serbia (No. 175087 and 175090).
Brian Weinshenker receives royalties from RSR Ltd, Oxford University, Hospices Civil de Lyon, and MVZ Labor PD Dr. Volkmann und Kollegen GbR for a patent of NMO-IgG as a diagnostic test for NMO and related disorders. He serves as a member of an adjudication committee for clinical trials in NMO being conducted by MedImmune and Alexion pharmaceutical companies. He is a consultant for Caladrius Biosciences regarding a clinical trial for NMO. He serves as a member of a data safety monitoring committee for clinical trials conducted by Novartis.
Jelena Drulovic serves on scientific advisory boards for Bayer Schering Pharma, Merck Serono, Teva, Genzyme, a Sanofi Company, Roche, and received honoraria for speaking from Merck Serono, Teva, Bayer Schering, Genzyme, a Sanofi Company, Medis; and has also received research grant support from the Ministry of Education and Science, Republic of Serbia (project no. 175031).