Apheresis therapies for NMOSD attacks: A retrospective study of 207 therapeutic interventions
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Apheresis therapies for NMOSD attacks: A retrospective study of 207 therapeutic interventions. / Kleiter, Ingo; Gahlen, Anna; Borisow, Nadja; Fischer, Katrin; Wernecke, Klaus-Dieter; Hellwig, Kerstin; Pache, Florence; Ruprecht, Klemens; Havla, Joachim; Kümpfel, Tania; Aktas, Orhan; Hartung, Hans-Peter; Ringelstein, Marius; Geis, Christian; Kleinschnitz, Christoph; Berthele, Achim; Hemmer, Bernhard; Angstwurm, Klemens; Stellmann, Jan-Patrick; Schuster, Simon; Stangel, Martin; Lauda, Florian; Tumani, Hayrettin; Mayer, Christoph; Krumbholz, Markus; Zeltner, Lena; Ziemann, Ulf; Linker, Ralf; Schwab, Matthias; Marziniak, Martin; Then Bergh, Florian; Hofstadt-van Oy, Ulrich; Neuhaus, Oliver; Zettl, Uwe K; Faiss, Jürgen; Wildemann, Brigitte; Paul, Friedemann; Jarius, Sven; Trebst, Corinna; NEMOS (Neuromyelitis Optica Study Group).
in: NEUROL-NEUROIMMUNOL, Jahrgang 5, Nr. 6, 11.2018, S. e504.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Apheresis therapies for NMOSD attacks: A retrospective study of 207 therapeutic interventions
AU - Kleiter, Ingo
AU - Gahlen, Anna
AU - Borisow, Nadja
AU - Fischer, Katrin
AU - Wernecke, Klaus-Dieter
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 - Stellmann, Jan-Patrick
AU - Schuster, Simon
AU - Stangel, Martin
AU - Lauda, Florian
AU - Tumani, Hayrettin
AU - Mayer, Christoph
AU - Krumbholz, Markus
AU - Zeltner, Lena
AU - Ziemann, Ulf
AU - Linker, Ralf
AU - Schwab, Matthias
AU - Marziniak, Martin
AU - Then Bergh, Florian
AU - Hofstadt-van Oy, Ulrich
AU - Neuhaus, Oliver
AU - Zettl, Uwe K
AU - Faiss, Jürgen
AU - Wildemann, Brigitte
AU - Paul, Friedemann
AU - Jarius, Sven
AU - Trebst, Corinna
AU - NEMOS (Neuromyelitis Optica Study Group)
PY - 2018/11
Y1 - 2018/11
N2 - 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-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).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.
AB - 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-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).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.
KW - Journal Article
U2 - 10.1212/NXI.0000000000000504
DO - 10.1212/NXI.0000000000000504
M3 - SCORING: Journal article
C2 - 30345331
VL - 5
SP - e504
JO - NEUROL-NEUROIMMUNOL
JF - NEUROL-NEUROIMMUNOL
SN - 2332-7812
IS - 6
ER -