Stellmann, Jan-Patrick and Krumbholz, Markus and Friede, Tim and Gahlen, Anna and Borisow, Nadja and Fischer, Katrin and Hellwig, Kerstin and Pache, Florence and Ruprecht, Klemens and Havla, Joachim and Kuempfel, Tania and Aktas, Orhan and Hartung, Hans-Peter and Ringelstein, Marius and Geis, Christian and Kleinschnitz, Christoph and Berthele, Achim and Hemmer, Bernhard and Angstwurm, Klemens and Young, Kim Lea and Schuster, Simon and Stangel, Martin and Lauda, Florian and Tumani, Hayrettin and Mayer, Christoph and Zeltner, Lena and Ziemann, Ulf and Linker, Ralf Andreas and Schwab, Matthias and Marziniak, Martin and Bergh, Florian Then and Hofstadt-van Oy, Ulrich and Neuhaus, Oliver and Zettl, Uwe and Faiss, Juergen and Wildemann, Brigitte and Paul, Friedemann and Jarius, Sven and Trebst, Corinna and Kleiter, Ingo (2017) Immunotherapies in neuromyelitis optica spectrum disorder: efficacy and predictors of response. JOURNAL OF NEUROLOGY NEUROSURGERY AND PSYCHIATRY, 88 (8). pp. 639-647. ISSN 0022-3050, 1468-330X
Full text not available from this repository. (Request a copy)Abstract
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-beta (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-beta, 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-beta.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | INTERFERON-BETA TREATMENT; MYCOPHENOLATE-MOFETIL; DIAGNOSTIC-CRITERIA; TREATMENT OUTCOMES; RITUXIMAB; TOLERABILITY; MULTICENTER; THERAPY; ECULIZUMAB; ANTIBODIES; |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Neurologie |
| Depositing User: | Dr. Gernot Deinzer |
| Date Deposited: | 14 Dec 2018 13:16 |
| Last Modified: | 19 Feb 2019 15:27 |
| URI: | https://pred.uni-regensburg.de/id/eprint/1497 |
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