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Apheresis therapies for NMOSD attacks: a retrospective study of 207 therapeutic interventions

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Item Type:Article
Title:Apheresis therapies for NMOSD attacks: a retrospective study of 207 therapeutic interventions
Creators Name:Kleiter, I. and Gahlen, A. and Borisow, N. and Fischer, K. and Wernecke, K.D. 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 Stellmann, J.P. and Schuster, S. and Stangel, M. and Lauda, F. and Tumani, H. and Mayer, C. and Krumbholz, M. and Zeltner, L. and Ziemann, U. and Linker, R. and Schwab, M. and Marziniak, M. and Then Bergh, F. and Hofstadt-van Oy, U. and Neuhaus, O. and Zettl, U.K. and Faiss, J. and Wildemann, B. and Paul, F. and Jarius, S. and Trebst, C.
Abstract:OBJECTIVE: To analyze whether 1 of the 2 apheresis techniques, therapeutic plasma exchange (PE) or immunoadsorption (IA), is superior in treating neuromyelitis optica spectrum disorder (NMOSD) attacks and to identify predictive factors for complete remission (CR). METHODS: This retrospective cohort study was based on the registry of the German Neuromyelitis Optica Study Group, a nationwide network established in 2008. It recruited patients with neuromyelitis optica diagnosed according to the 2006 Wingerchuk criteria or with aquaporin-4 (AQP4-ab)-antibody-seropositive NMOSD treated at 6 regional hospitals and 16 tertiary referral centers until March 2013. Besides descriptive data analysis of patient and attack characteristics, generalized estimation equation (GEE) analyses were applied to compare the effectiveness of the 2 apheresis techniques. A GEE model was generated to assess predictors of outcome. RESULTS: Two hundred and seven attacks in 105 patients (87% AQP4-ab-antibody seropositive) were treated with at least 1 apheresis therapy. Neither PE nor IA was proven superior in the therapy of NMOSD attacks. CR was only achieved with early apheresis therapy. Strong predictors for CR were the use of apheresis therapy as first-line therapy (OR 12.27, 95% CI: 1.04-144.91, p = 0.047), time from onset of attack to start of therapy in days (OR 0.94, 95% CI: 0.89-0.99, p = 0.014), the presence of AQP4-abantibodies (OR 33.34, 95% CI: 1.76-631.17, p = 0.019), and monofocal attack manifestation (OR 4.71, 95% CI: 1.03-21.62, p = 0.046). CONCLUSIONS: Our findings suggest early use of an apheresis therapy in NMOSD attacks, particularly in AQP4-ab-seropositive patients. No superiority was shown for one of the 2 apheresis techniques. CLASSIFICATION OF EVIDENCE: This study provides Class IV evidence that for patients with NMOSD, neither PE nor IA is superior in the treatment of attacks.
Source:Neurology Neuroimmunology & Neuroinflammation
ISSN:2332-7812
Publisher:American Academy of Neurology (U.S.A.)
Volume:5
Number:6
Page Range:e504
Date:November 2018
Official Publication:https://doi.org/10.1212/NXI.0000000000000504
PubMed:View item in PubMed

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