Ingo Wolfram Kleiter, Corinna Trebst, Kerstin Hellwig, Ralf Linker, Matthias Schwab, Anna Maria Gahlen, Nadja Borisow, Katrin Fischer, Florence Pache, Klemens Ruprecht, Joachim Havla, Tanja Kümpfel, Orhan Aktas, Hans-Peter Hartung, Marius Ringelstein, Christian Geis, Christoph Kleinschnitz, Achim Berthele, Bernhard Hemmer, Klemens Angstwurm, Jan-Patrick Steilmann, Simon Schuster, Martin Stangel, Florian Lauda, Hayrettin Tumani, Christoph Mayer, Markus Krumpholz, Lena Zeltner, Ulf Ziermann, Martin Marziniak, Florian Then Bergh, Ulrich Hofstadt-van Oy, Oliver Neuhaus, Uwe K. Zettl, Jürgen Faiss, Brigitte Wildemann, Friedemann Paul, Sven Jarius, Klaus-Dieter Wernecke
- \(\bf Objective\)
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).
\(\bf Methods\)
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.
\(\bf Results\)
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, \(\it {p}\) = 0.047), time from onset of attack to start of therapy in days (OR 0.94, 95% CI: 0.89–0.99, \(\it {p}\) = 0.014), the presence of AQP4-abantibodies (OR 33.34, 95% CI: 1.76–631.17, \(\it {p}\) = 0.019), and monofocal attack manifestation (OR 4.71, 95% CI: 1.03–21.62, \(\it {p}\) = 0.046).
\(\bf Conclusions\)
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.
\(\textbf {Classification of evidence}\)
This study provides Class IV evidence that for patients with NMOSD, neither PE nor IA is superior in the treatment of attacks.
MetadatenAuthor: | Ingo Wolfram KleiterGND, Corinna TrebstGND, Kerstin HellwigORCiDGND, Ralf LinkerORCiDGND, Matthias SchwabGND, Anna Maria GahlenGND, Nadja BorisowGND, Katrin Fischer, Florence PacheGND, Klemens RuprechtGND, Joachim Havla, Tanja Kümpfel, Orhan AktasGND, Hans-Peter Hartung, Marius Ringelstein, Christian Geis, Christoph Kleinschnitz, Achim Berthele, Bernhard Hemmer, Klemens AngstwurmGND, Jan-Patrick Steilmann, Simon Schuster, Martin Stangel, Florian Lauda, Hayrettin Tumani, Christoph Mayer, Markus Krumpholz, Lena Zeltner, Ulf Ziermann, Martin Marziniak, Florian Then Bergh, Ulrich Hofstadt-van Oy, Oliver Neuhaus, Uwe K. Zettl, Jürgen Faiss, Brigitte Wildemann, Friedemann Paul, Sven JariusGND, Klaus-Dieter Wernecke |
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URN: | urn:nbn:de:hbz:294-64046 |
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DOI: | https://doi.org/10.1212/NXI.0000000000000504 |
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Parent Title (English): | Neurology : Neuroimmunology & Neuroinflammation |
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Subtitle (English): | a retrospective study of 207 therapeutic interventions |
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Document Type: | Article |
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Language: | English |
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Date of Publication (online): | 2019/05/02 |
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Date of first Publication: | 2018/09/26 |
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Publishing Institution: | Ruhr-Universität Bochum, Universitätsbibliothek |
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Tag: | Open Access Fonds |
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Volume: | 5 |
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Issue: | 6 |
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First Page: | e504-1 |
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Last Page: | e504-12 |
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Note: | Article Processing Charge funded by the Deutsche Forschungsgemeinschaft (DFG) and the Open Access Publication Fund of Ruhr-Universität Bochum. |
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Institutes/Facilities: | St. Josef-Hospital Bochum, Neurologische Klinik |
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Dewey Decimal Classification: | Technik, Medizin, angewandte Wissenschaften / Medizin, Gesundheit |
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open_access (DINI-Set): | open_access |
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faculties: | Medizinische Fakultät |
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Licence (English): | Creative Commons - CC BY-NC-ND 4.0 - Attribution-NonCommercial-NoDerivatives 4.0 International |
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