Kleiter, Ingo and Gahlen, Anna and Borisow, Nadja and Fischer, Katrin and Wernecke, Klaus-Dieter and Wegner, Brigitte and Hellwig, Kerstin and Pache, Florence and Ruprecht, Klemens and Havla, Joachim and Krumbholz, Markus 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 Stellmann, Jan-Patrick and Schuster, Simon and Stangel, Martin and Lauda, Florian and Tumani, Hayrettin and Mayer, Christoph and Zeltner, Lena and Ziemann, Ulf and Linker, Ralf and Schwab, Matthias and Marziniak, Martin and Bergh, Florian Then and Hofstadt-van Oy, Ulrich and Neuhaus, Oliver and Winkelmann, Alexander and Marouf, Wael and Faiss, Juergen and Wildemann, Brigitte and Paul, Friedemann and Jarius, Sven and Trebst, Corinna (2016) Neuromyelitis optica: Evaluation of 871 attacks and 1,153 treatment courses. ANNALS OF NEUROLOGY, 79 (2). pp. 206-216. ISSN 0364-5134, 1531-8249
Full text not available from this repository. (Request a copy)Abstract
ObjectiveNeuromyelitis optica (NMO) attacks often are severe, are difficult to treat, and leave residual deficits. Here, we analyzed the frequency, sequence, and efficacy of therapies used for NMO attacks. MethodsA retrospective review was made of patient records to assess demographic/diagnostic data, attack characteristics, therapies, and the short-term remission status (complete remission [CR], partial remission [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 (GEEs), a patient-based statistical approach. ResultsA total of 871 attacks in 185 patients (142 NMO/43 NMOSD, 82% female) were analyzed. The 1,153 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 test). Remission rates were higher for isolated optic neuritis versus isolated myelitis (p<0.001), and for unilateral versus 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 (odds ratio [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 versus HD-S (OR=4.38, p=0.006). InterpretationParticularly myelitis and bilateral optic neuritis have poor remission rates. Escalation of attack therapy improves outcome. PE/IA may increase recovery in isolated myelitis. Ann Neurol 2016;79:206-216
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | INFLAMMATORY DEMYELINATING DISEASE; PLASMA-EXCHANGE; MULTIPLE-SCLEROSIS; IMMUNOADSORPTION THERAPY; SPECTRUM DISORDERS; CNS DEMYELINATION; NEURITIS; PREDICTORS; EFFICACY; |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Neurologie |
| Depositing User: | Dr. Gernot Deinzer |
| Date Deposited: | 13 Mar 2019 07:26 |
| Last Modified: | 13 Mar 2019 07:26 |
| URI: | https://pred.uni-regensburg.de/id/eprint/2442 |
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