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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, Vol. 5, No. 6, 11.2018, p. e504.

Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review

Harvard

Kleiter, I, Gahlen, A, Borisow, N, Fischer, K, Wernecke, K-D, Hellwig, K, Pache, F, Ruprecht, K, Havla, J, Kümpfel, T, Aktas, O, Hartung, H-P, Ringelstein, M, Geis, C, Kleinschnitz, C, Berthele, A, Hemmer, B, Angstwurm, K, Stellmann, J-P, Schuster, S, Stangel, M, Lauda, F, Tumani, H, Mayer, C, Krumbholz, M, Zeltner, L, Ziemann, U, Linker, R, Schwab, M, Marziniak, M, Then Bergh, F, Hofstadt-van Oy, U, Neuhaus, O, Zettl, UK, Faiss, J, Wildemann, B, Paul, F, Jarius, S, Trebst, C & NEMOS (Neuromyelitis Optica Study Group) 2018, 'Apheresis therapies for NMOSD attacks: A retrospective study of 207 therapeutic interventions', NEUROL-NEUROIMMUNOL, vol. 5, no. 6, pp. e504. https://doi.org/10.1212/NXI.0000000000000504

APA

Kleiter, I., Gahlen, A., Borisow, N., Fischer, K., Wernecke, K-D., Hellwig, K., Pache, F., Ruprecht, K., Havla, J., Kümpfel, T., Aktas, O., Hartung, H-P., Ringelstein, M., Geis, C., Kleinschnitz, C., Berthele, A., Hemmer, B., Angstwurm, K., Stellmann, J-P., ... NEMOS (Neuromyelitis Optica Study Group) (2018). Apheresis therapies for NMOSD attacks: A retrospective study of 207 therapeutic interventions. NEUROL-NEUROIMMUNOL, 5(6), e504. https://doi.org/10.1212/NXI.0000000000000504

Vancouver

Kleiter I, Gahlen A, Borisow N, Fischer K, Wernecke K-D, Hellwig K et al. Apheresis therapies for NMOSD attacks: A retrospective study of 207 therapeutic interventions. NEUROL-NEUROIMMUNOL. 2018 Nov;5(6):e504. https://doi.org/10.1212/NXI.0000000000000504

Bibtex

@article{b91b4ae950cb47b4868bc79f3fcbd100,
title = "Apheresis therapies for NMOSD attacks: A retrospective study of 207 therapeutic interventions",
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-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.",
keywords = "Journal Article",
author = "Ingo Kleiter and Anna Gahlen and Nadja Borisow and Katrin Fischer and Klaus-Dieter Wernecke and Kerstin Hellwig and Florence Pache and Klemens Ruprecht and Joachim Havla and Tania K{\"u}mpfel and Orhan Aktas and Hans-Peter Hartung and Marius Ringelstein and Christian Geis and Christoph Kleinschnitz and Achim Berthele and Bernhard Hemmer and Klemens Angstwurm and Jan-Patrick Stellmann and Simon Schuster and Martin Stangel and Florian Lauda and Hayrettin Tumani and Christoph Mayer and Markus Krumbholz and Lena Zeltner and Ulf Ziemann and Ralf Linker and Matthias Schwab and Martin Marziniak and {Then Bergh}, Florian and {Hofstadt-van Oy}, Ulrich and Oliver Neuhaus and Zettl, {Uwe K} and J{\"u}rgen Faiss and Brigitte Wildemann and Friedemann Paul and Sven Jarius and Corinna Trebst and {NEMOS (Neuromyelitis Optica Study Group)}",
year = "2018",
month = nov,
doi = "10.1212/NXI.0000000000000504",
language = "English",
volume = "5",
pages = "e504",
journal = "NEUROL-NEUROIMMUNOL",
issn = "2332-7812",
publisher = "Lippincott Williams and Wilkins",
number = "6",

}

RIS

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 -