TY - JOUR
T1 - Immunotherapies in neuromyelitis optica spectrum disorder
T2 - Efficacy and predictors of response
AU - NEMOS (Neuromyelitis Optica Study Group)
AU - Stellmann, Jan Patrick
AU - Krumbholz, Markus
AU - Friede, Tim
AU - Gahlen, Anna
AU - Borisow, Nadja
AU - Fischer, Katrin
AU - Hellwig, Kerstin
AU - Pache, Florence
AU - Ruprecht, Klemens
AU - Havla, Joachim
AU - Kümpfel, Tania
AU - Aktas, Orhan
AU - Hartung, Hans Peter
AU - Ringelstein, Marius
AU - Geis, Christian
AU - Kleinschnitz, Christoph
AU - Berthele, Achim
AU - Hemmer, Bernhard
AU - Angstwurm, Klemens
AU - Young, Kim Lea
AU - Schuster, Simon
AU - Stangel, Martin
AU - Lauda, Florian
AU - Tumani, Hayrettin
AU - Mayer, Christoph
AU - Zeltner, Lena
AU - Ziemann, Ulf
AU - Linker, Ralf Andreas
AU - Schwab, Matthias
AU - Marziniak, Martin
AU - Then Bergh, Florian
AU - Hofstadt-Van Oy, Ulrich
AU - Neuhaus, Oliver
AU - Zettl, Uwe
AU - Faiss, Jürgen
AU - Wildemann, Brigitte
AU - Paul, Friedemann
AU - Jarius, Sven
AU - Trebst, Corinna
AU - Kleiter, Ingo
N1 - Publisher Copyright:
© 2017 Article author(s).
PY - 2017/8/1
Y1 - 2017/8/1
N2 - 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-β (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-β, 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-β.
AB - 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-β (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-β, 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-β.
KW - Aquaporin-4 antibody
KW - Azathioprine
KW - Neuromyelitis optica spectrum disorder
KW - Rituximab
KW - Therapy
UR - http://www.scopus.com/inward/record.url?scp=85024391017&partnerID=8YFLogxK
U2 - 10.1136/jnnp-2017-315603
DO - 10.1136/jnnp-2017-315603
M3 - Article
C2 - 28572277
AN - SCOPUS:85024391017
SN - 0022-3050
VL - 88
SP - 639
EP - 647
JO - Journal of Neurology, Neurosurgery and Psychiatry
JF - Journal of Neurology, Neurosurgery and Psychiatry
IS - 8
ER -