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Apheresis therapies for NMOSD attacks

2018; Wolters Kluwer; Volume: 5; Issue: 6 Linguagem: Inglês

10.1212/nxi.0000000000000504

2332-7812

Ingo Kleiter, Anna Gahlen, Nadja Borisow, Katrin Fischer, Klaus–Dieter Wernecke, Kerstin Hellwig, Florence Pache, Klemens Ruprecht, Joachim Havla, Tania Kümpfel, Orhan Aktaş, Hans‐Peter Hartung, Marius Ringelstein, Christian Geis, Christoph Kleinschnitz, Achim Berthele, Bernhard Hemmer, Klemens Angstwurm, Jan‐Patrick Stellmann, S. Schuster, Martin Stangel, Florian Lauda, Hayrettin Tumani, Christoph Mayer, Markus Krumbholz, Lena Zeltner, Ulf Ziemann, Ralf A. Linker, Matthias Schwab, Martin Marziniak, Florian Then Bergh, Ulrich Hofstadt‐van Oy, Oliver Neuhaus, Uwe K. Zettl, Jürgen Faiss, Brigitte Wildemann, Friedemann Paul, Sven Jarius, Corinna Trebst, Philipp Albrecht, Ilya Ayzenberg, Antonios Bayas, Judith Bellmann‐Strobl, F. Bischof, Stefan Bittner, Tobias Böttcher, Johannes Brettschneider, Mathias Buttmann, Marcus D’Souza, Barbara Ettrich, Benedikt Frank, Achim Gass, Matthias Grothe, Kersten Guthke, Axel Haarmann, Eva Marie Habedank, F. Hoffmann, Olaf Hoffmann, Martin W. Hümmert, Jutta Junghans, Markku Kaste, Barbara Kaulen, Pawel Kermer, Peter Kern, Luisa Klotz, Wolfgang Köhler, E. Kolesilova, Melanie Korsen, Markus C. Kowarik, Stefan Langel, D.H. Lee, Martin Liebetrau, Felix Luessi, Wael Marouf, Stefanie Meister, Arthur Melms, Imke Metz, Christoph Münch, Sabine Niehaus, Marc Pawlitzki, Hannah Pellkofer, Hans-Ulrich Puhlmann, Refik Pul, N. Retzlaf, Arne Riedlinger, Paulus Rommer, Luise Röpke, Kevin Rostásy, Lioba Rückriem, Christoph Ruschil, Sven Schippling, Makbule Şenel, Joern P. Sieb, Claudia Sommer, Annette Spreer, Andreas Steinbrecher, Heike Stephanik, Muriel Stoppe, Marie Süße, Björn Tackenberg, Johannes Tünnerhoff, Christian Veauthier, Annette O. Walter, Klaus‐Peter Wandinger, Clemens Warnke, Martin S. Weber, Robert Weissert, Heinz Wiendl, Christian Wilke, Alexander Winkelmann, Yavor Yalachkov, Kim Lea Young, Christian Zentner, Frauke Zipp,

Hereditary Neurological Disorders

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).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.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-ab-antibodies (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).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.This study provides Class IV evidence that for patients with NMOSD, neither PE nor IA is superior in the treatment of attacks.