Apheresis therapies for NMOSD attacks A retrospective study of 207 therapeutic interventions

Ingo Kleiter, Anna Gahlen, Nadja Borisow, Katrin Fischer, Klaus Dieter Wernecke, Kerstin Hellwig, Florence Pache, Klemens Ruprecht, Joachim Havla, Tania Kumpfel, Orhan Aktas, Hans Peter Hartung, Marius Ringelstein, Christian Geis, Christoph Kleinschnitz, Achim Berthele, Bernhard Hemmer, Klemens Angstwurm, Jan Patrick Stellmann, Simon SchusterMartin Stangel, Florian Lauda, Hayrettin Tumani, Christoph Mayer, Markus Krumbholz, Lena Zeltner, Ulf Ziemann, Ralf Linker, Matthias Schwab, Martin Marziniak, Florian Then Bergh, Ulrich Hofstadt Van Oy, Oliver Neuhaus, Uwe K. Zettl, Jurgen Faiss, Brigitte Wildemann, Friedemann Paul, Sven Jarius, Corinna Trebst

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160 Scopus citations

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.

Original languageEnglish
Article numbere504
JournalNeurology: Neuroimmunology and NeuroInflammation
Volume5
Issue number6
DOIs
StatePublished - 1 Nov 2018
Externally publishedYes

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