Apheresis therapies for NMOSD attacks: A retrospective study of 207 therapeutic interventions

Kleiter I, Gahlen A, Borisow N, Fischer K, Wernecke KD, Hellwig K, Pache F, Ruprecht K, Havla J, Kumpfel T, Aktas O, Hartung HP, Ringelstein M, Geis C, Kleinschnitz C, Berthele A, Hemmer B, Angstwurm K, Stellmann JP, Schuster S, Stangel M, Lauda F, Tumani H, Mayer C, Krumbholz M, Zeltner L, Ziemann U, Linker R, Schwab M, Marziniak M, Bergh FT, Hofstadt-Van Oy U, Neuhaus O, Zettl UK, Faiss J, Wildemann B, Paul F, Jarius S, Trebst C (2018)

Publication Type: Journal article

Publication year: 2018

Journal

Book Volume: 5

Pages Range: e504

Journal Issue: 6

DOI: 10.1212/NXI.0000000000000504

Abstract

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).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.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, = 0.047), time from onset of attack to start of therapy in days (OR 0.94, 95% CI: 0.89-0.99, = 0.014), the presence of AQP4-ab-antibodies (OR 33.34, 95% CI: 1.76-631.17, = 0.019), and monofocal attack manifestation (OR 4.71, 95% CI: 1.03-21.62, = 0.046).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.This study provides Class IV evidence that for patients with NMOSD, neither PE nor IA is superior in the treatment of attacks.

Authors with CRIS profile

Involved external institutions

Ruhr-Universität Bochum (RUB) Germany (DE) Asklepios Kliniken Germany (DE) Sostana GmbH Germany (DE) Charité - Universitätsmedizin Berlin Germany (DE) Ludwig-Maximilians-Universität (LMU) Germany (DE) Goethe-Universität Frankfurt am Main Germany (DE) Heinrich-Heine-Universität Düsseldorf Germany (DE) Universitätsklinikum Jena Germany (DE) Universitätsklinikum Essen Germany (DE) Technische Universität München (TUM) Germany (DE) Universitätsklinikum Regensburg Germany (DE) Universitätsklinikum Hamburg-Eppendorf (UKE) Germany (DE) Medizinische Hochschule Hannover (MHH) / Hannover Medical School Germany (DE) Universität Ulm Germany (DE) Eberhard Karls Universität Tübingen Germany (DE) kbo-Heckscher-Klinikum gGmbH Germany (DE) Universität Leipzig Germany (DE) Klinikum Westfalen Germany (DE) Universität Rostock Germany (DE) Ruprecht-Karls-Universität Heidelberg Germany (DE)

How to cite

APA:

Kleiter, I., Gahlen, A., Borisow, N., Fischer, K., Wernecke, K.-D., Hellwig, K.,... Trebst, C. (2018). Apheresis therapies for NMOSD attacks: A retrospective study of 207 therapeutic interventions. Neurology, Neuroimmunology and Neuroinflammation, 5(6), e504. https://doi.org/10.1212/NXI.0000000000000504

MLA:

Kleiter, Ingo, et al. "Apheresis therapies for NMOSD attacks: A retrospective study of 207 therapeutic interventions." Neurology, Neuroimmunology and Neuroinflammation 5.6 (2018): e504.

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