TY  - JOUR
A1  - Kleiter, Ingo
A1  - Gahlen, Anna
A1  - Borisow, Nadja
A1  - Fischer, Katrin
A1  - Wernecke, Klaus-Dieter
A1  - Hellwig, Kerstin
A1  - Pache, Florence
A1  - Ruprecht, Klemens
A1  - Havla, Joachim
A1  - Kümpfel, Tania
A1  - Aktas, Orhan
A1  - Hartung, Hans-Peter
A1  - Ringelstein, Marius
A1  - Geis, Christian
A1  - Kleinschnitz, Christoph
A1  - Berthele, Achim
A1  - Hemmer, Bernhard
A1  - Angstwurm, Klemens
A1  - Stellmann, Jan-Patrick
A1  - Schuster, Simon
A1  - Stangel, Martin
A1  - Lauda, Florian
A1  - Tumani, Hayrettin
A1  - Mayer, Christoph
A1  - Krumbholz, Markus
A1  - Zeltner, Lena
A1  - Ziemann, Ulf
A1  - Linker, Ralf
A1  - Schwab, Matthias
A1  - Marziniak, Martin
A1  - Then Bergh, Florian
A1  - Hofstadt-van Oy, Ulrich
A1  - Neuhaus, Oliver
A1  - Zettl, Uwe K.
A1  - Faiss, Jürgen Hartmut
A1  - Wildemann, Brigitte
A1  - Paul, Friedemann
A1  - Jarius, Sven
A1  - Trebst, Corinna
T1  - Apheresis therapies for NMOSD attacks : a retrospective study of 207 therapeutic interventions
T2  - Neuroimmunology and neuroinflammation
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.
Y1  - 2018
UR  - http://publikationen.ub.uni-frankfurt.de/frontdoor/index/index/docId/47573
UR  - https://nbn-resolving.org/urn:nbn:de:hebis:30:3-475732
SN  - 2349-6142
SN  - 2347-8659
N1  - This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License 4.0 (CC BY-NC-ND), which permits downloading and sharing the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
VL  - 5
IS  - 6, e504
SP  - 1
EP  - 12
PB  - Hongkong Partner Publ.
CY  - Hong Kong
ER  -