![[feed]](/style/images/feed-icon-14x14.png){kind=icon}
Tools
Tools
Preview |
PDF
- Requires a PDF viewer such as GSview, Xpdf or Adobe Acrobat Reader
1MB |
| Item Type: | Article |
|---|---|
| Title: | Immunotherapies in neuromyelitis optica spectrum disorder: efficacy and predictors of response |
| Creators Name: | Stellmann, J.P., Krumbholz, M., Friede, T., Gahlen, A., Borisow, N., Fischer, K., Hellwig, K., Pache, F., Ruprecht, K., Havla, J., Kümpfel, T., Aktas, O., Hartung, H.P., Ringelstein, M., Geis, C., Kleinschnitz, C., Berthele, A., Hemmer, B., Angstwurm, K., Young, K.L., Schuster, S., Stangel, M., Lauda, F., Tumani, H., Mayer, C., Zeltner, L., Ziemann, U., Linker, R.A., Schwab, M., Marziniak, M., Then Bergh, F., Hofstadt-van Oy, U., Neuhaus, O., Zettl, U., Faiss, J., Wildemann, B., Paul, F., Jarius, S., Trebst, C. and Kleiter, I. |
| Abstract: | OBJECTIVE: To analyse predictors for relapses and number of attacks under different immunotherapies in patients with neuromyelitis optica spectrum disorder (NMOSD). DESIGN: This is a retrospective cohort study conducted in neurology departments at 21 regional and university hospitals in Germany. Eligible participants were patients with aquaporin-4-antibody-positive or aquaporin-4-antibody-negative NMOSD. Main outcome measures were HRs from Cox proportional hazard regression models adjusted for centre effects, important prognostic factors and repeated treatment episodes. RESULTS: 265 treatment episodes with a mean duration of 442 days (total of 321 treatment years) in 144 patients (mean age at first attack: 40.9 years, 82.6% female, 86.1% aquaporin-4-antibody-positive) were analysed. 191 attacks occurred during any of the treatments (annual relapse rate=0.60). The most common treatments were rituximab (n=77, 111 patient-years), azathioprine (n=52, 68 patient-years), interferon-beta (n=32, 61 patient-years), mitoxantrone (n=34, 32.1 patient-years) and glatiramer acetate (n=17, 10 patient-years). Azathioprine (HR=0.4, 95% CI 0.3 to 0.7, p=0.001) and rituximab (HR=0.6, 95% CI 0.4 to 1.0, p=0.034) reduced the attack risk compared with interferon-beta, whereas mitoxantrone and glatiramer acetate did not. Patients who were aquaporin-4-antibody-positive had a higher risk of attacks (HR=2.5, 95% CI 1.3 to 5.1, p=0.009). Every decade of age was associated with a lower risk for attacks (HR=0.8, 95% CI 0.7 to 1.0, p=0.039). A previous attack under the same treatment tended to be predictive for further attacks (HR=1.5, 95% CI 1.0 to 2.4, p=0.065). CONCLUSIONS: Age, antibody status and possibly previous attacks predict further attacks in patients treated for NMOSD. Azathioprine and rituximab are superior to interferon-beta. |
| Keywords: | Aquaporin 4, Autoantibodies, Azathioprine, Cohort Studies, Follow-Up Studies, Germany, Glatiramer Acetate, Immunotherapy, Interferon-beta, Long-Term Care, Mitoxantrone, Neuromyelitis Optica, Prognosis, Recurrence, Registries, Retrospective Studies, Rituximab, Treatment Outcome |
| Source: | Journal of Neurology Neurosurgery and Psychiatry |
| ISSN: | 0022-3050 |
| Publisher: | BMJ Publishing Group |
| Volume: | 88 |
| Number: | 8 |
| Page Range: | 639-647 |
| Date: | August 2017 |
| Official Publication: | https://doi.org/10.1136/jnnp-2017-315603 |
| PubMed: | View item in PubMed |
Repository Staff Only: item control page
