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Immunotherapies in neuromyelitis optica spectrum disorder: efficacy and predictors of response

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Item Type:Article
Title:Immunotherapies in neuromyelitis optica spectrum disorder: efficacy and predictors of response
Creators Name:Stellmann, J.P. and Krumbholz, M. and Friede, T. and Gahlen, A. and Borisow, N. and Fischer, K. and Hellwig, K. and Pache, F. and Ruprecht, K. and Havla, J. and Kümpfel, T. and Aktas, O. and Hartung, H.P. and Ringelstein, M. and Geis, C. and Kleinschnitz, C. and Berthele, A. and Hemmer, B. and Angstwurm, K. and Young, K.L. and Schuster, S. and Stangel, M. and Lauda, F. and Tumani, H. and Mayer, C. and Zeltner, L. and Ziemann, U. and Linker, R.A. and Schwab, M. and Marziniak, M. and Then Bergh, F. and Hofstadt-van Oy, U. and Neuhaus, O. and Zettl, U. and Faiss, J. and Wildemann, B. and Paul, F. and Jarius, S. and 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
Publisher:BMJ Publishing Group
Page Range:639-647
Date:August 2017
Official Publication:https://doi.org/10.1136/jnnp-2017-315603
PubMed:View item in PubMed

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