Neuromyelitis optica: Evaluation of 871 attacks and 1153 treatment courses
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Neuromyelitis optica: Evaluation of 871 attacks and 1153 treatment courses. / Kleiter, Ingo; Gahlen, Anna; Borisow, Nadja; Fischer, Katrin; Wernecke, Klaus-Dieter; Wegner, Brigitte; Hellwig, Kerstin; Pache, Florence; Ruprecht, Klemens; Havla, Joachim; Krumbholz, Markus; 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; Zeltner, Lena; Ziemann, Ulf; Linker, Ralf; Schwab, Matthias; Marziniak, Martin; Bergh, Florian Then; Hofstadt-van Oy, Ulrich; Neuhaus, Oliver; Winkelmann, Alexander; Marouf, Wael; Faiss, Jürgen; Wildemann, Brigitte; Paul, Friedemann; Jarius, Sven; Trebst, Corinna; NEMOS (Neuromyelitis Optica Study Group).
In: ANN NEUROL, Vol. 79, No. 2, 02.2016, p. 206-16.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Neuromyelitis optica: Evaluation of 871 attacks and 1153 treatment courses
AU - Kleiter, Ingo
AU - Gahlen, Anna
AU - Borisow, Nadja
AU - Fischer, Katrin
AU - Wernecke, Klaus-Dieter
AU - Wegner, Brigitte
AU - Hellwig, Kerstin
AU - Pache, Florence
AU - Ruprecht, Klemens
AU - Havla, Joachim
AU - Krumbholz, Markus
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 - Zeltner, Lena
AU - Ziemann, Ulf
AU - Linker, Ralf
AU - Schwab, Matthias
AU - Marziniak, Martin
AU - Bergh, Florian Then
AU - Hofstadt-van Oy, Ulrich
AU - Neuhaus, Oliver
AU - Winkelmann, Alexander
AU - Marouf, Wael
AU - Faiss, Jürgen
AU - Wildemann, Brigitte
AU - Paul, Friedemann
AU - Jarius, Sven
AU - Trebst, Corinna
AU - NEMOS (Neuromyelitis Optica Study Group)
N1 - © 2015 American Neurological Association.
PY - 2016/2
Y1 - 2016/2
N2 - OBJECTIVE: Neuromyelitis optica (NMO) attacks are often severe, difficult to treat, and leave residual deficits. Here, we analyzed the frequency, sequence, and efficacy of therapies used for NMO attacks.METHODS: Retrospective review of patient records to assess demographic/diagnostic data, attack characteristics, therapies, and the short-term remission status (complete, CR; partial, PR; no remission, NR). Inclusion criteria were NMO according to Wingerchuk's 2006 criteria or aquaporin-4 antibody-positive NMO spectrum disorder (NMOSD). Remission status was analyzed with generalized estimating equations (GEE), a patient-based statistical approach.RESULTS: 871 attacks in 185 patients (142 NMO/43 NMOSD, 82% female) were analyzed. The 1153 treatment courses comprised high-dose intravenous steroids (HD-S, n=810), plasma exchange (PE, n=192), immunoadsorption (IA, n=38), other (n=80), and unknown (n=33) therapies. The first treatment course led to CR in 19.1%, PR in 64.5%, and NR in 16.4% of attacks. Second, third, fourth, and fifth treatment courses were given in 28.2%, 7.1%, 1.4%, and 0.5% of attacks, respectively. This escalation of attack therapy significantly improved outcome (p<0.001, Bowker's test). Remission rates were higher for isolated optic neuritis vs. isolated myelitis (p<0.001,), and for unilateral vs. bilateral optic neuritis (p=0.020). Isolated myelitis responded better to PE/IA than to HD-S as first treatment course (p=0.037). Predictors of CR in multivariate GEE analysis were age (OR=0.97; p=0.011), presence of myelitis (OR=0.38; p=0.002), CR from previous attack (OR=6.85; p<0.001), and first-line PE/IA vs. HD-S (OR=4.38; p=0.006).INTERPRETATION: Particularly myelitis and bilateral ON have poor remission rates. Escalation of attack therapy improves outcome. PE/IA may increase recovery in isolated myelitis.
AB - OBJECTIVE: Neuromyelitis optica (NMO) attacks are often severe, difficult to treat, and leave residual deficits. Here, we analyzed the frequency, sequence, and efficacy of therapies used for NMO attacks.METHODS: Retrospective review of patient records to assess demographic/diagnostic data, attack characteristics, therapies, and the short-term remission status (complete, CR; partial, PR; no remission, NR). Inclusion criteria were NMO according to Wingerchuk's 2006 criteria or aquaporin-4 antibody-positive NMO spectrum disorder (NMOSD). Remission status was analyzed with generalized estimating equations (GEE), a patient-based statistical approach.RESULTS: 871 attacks in 185 patients (142 NMO/43 NMOSD, 82% female) were analyzed. The 1153 treatment courses comprised high-dose intravenous steroids (HD-S, n=810), plasma exchange (PE, n=192), immunoadsorption (IA, n=38), other (n=80), and unknown (n=33) therapies. The first treatment course led to CR in 19.1%, PR in 64.5%, and NR in 16.4% of attacks. Second, third, fourth, and fifth treatment courses were given in 28.2%, 7.1%, 1.4%, and 0.5% of attacks, respectively. This escalation of attack therapy significantly improved outcome (p<0.001, Bowker's test). Remission rates were higher for isolated optic neuritis vs. isolated myelitis (p<0.001,), and for unilateral vs. bilateral optic neuritis (p=0.020). Isolated myelitis responded better to PE/IA than to HD-S as first treatment course (p=0.037). Predictors of CR in multivariate GEE analysis were age (OR=0.97; p=0.011), presence of myelitis (OR=0.38; p=0.002), CR from previous attack (OR=6.85; p<0.001), and first-line PE/IA vs. HD-S (OR=4.38; p=0.006).INTERPRETATION: Particularly myelitis and bilateral ON have poor remission rates. Escalation of attack therapy improves outcome. PE/IA may increase recovery in isolated myelitis.
U2 - 10.1002/ana.24554
DO - 10.1002/ana.24554
M3 - SCORING: Journal article
C2 - 26537743
VL - 79
SP - 206
EP - 216
JO - ANN NEUROL
JF - ANN NEUROL
SN - 0364-5134
IS - 2
ER -
