Immunotherapies in neuromyelitis optica spectrum disorder: efficacy and predictors of response

Stellmann JP, Krumbholz M, Friede T, Gahlen A, Borisow N, Fischer K, Hellwig K, Pache F, Ruprecht K, Havla J, Kuempfel T, Aktas O, Hartung HP, Ringelstein M, Geis C, Kleinschnitz C, Berthele A, Hemmer B, Angstwurm K, Young KL, Schuster S, Stangel M, Lauda F, Tumani H, Mayer C, Zeltner L, Ziemann U, Linker R, Schwab M, Marziniak M, Bergh FT, Hofstadt-Van Oy U, Neuhaus O, Zettl U, Faiss J, Wildemann B, Paul F, Jarius S, Trebst C, Kleiter I (2017)


Publication Type: Journal article

Publication year: 2017

Journal

Book Volume: 88

Pages Range: 639-647

Journal Issue: 8

DOI: 10.1136/jnnp-2017-315603

Abstract

To analyse predictors for relapses and number of attacks under different immunotherapies in patients with neuromyelitis optica spectrum disorder (NMOSD).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.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-? (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-?, 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).Age, antibody status and possibly previous attacks predict further attacks in patients treated for NMOSD. Azathioprine and rituximab are superior to interferon-?.

Authors with CRIS profile

Involved external institutions

How to cite

APA:

Stellmann, J.-P., Krumbholz, M., Friede, T., Gahlen, A., Borisow, N., Fischer, K.,... Kleiter, I. (2017). Immunotherapies in neuromyelitis optica spectrum disorder: efficacy and predictors of response. Journal of Neurology Neurosurgery and Psychiatry, 88(8), 639-647. https://dx.doi.org/10.1136/jnnp-2017-315603

MLA:

Stellmann, Jan-Patrick, et al. "Immunotherapies in neuromyelitis optica spectrum disorder: efficacy and predictors of response." Journal of Neurology Neurosurgery and Psychiatry 88.8 (2017): 639-647.

BibTeX: Download