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Treffer: Neuromyelitis optica: Evaluation of 871 attacks and 1,153 treatment courses.

Title:
Neuromyelitis optica: Evaluation of 871 attacks and 1,153 treatment courses.
Authors:
Kleiter I; Department of Neurology, St. Josef-Hospital, Ruhr University Bochum, Bochum., Gahlen A; Department of Neurology, St. Josef-Hospital, Ruhr University Bochum, Bochum., Borisow N; NeuroCure Clinical Research Center and Experimental and Clinical Research Center, Charité University Medicine, and Max Delbrueck Center for Molecular Medicine, Berlin., Fischer K; Department of Neurology, Asklepios Clinic Teupitz, Teupitz., Wernecke KD; Clinical Research Organisation Sostana and Charité University Medicine, Berlin., Wegner B; Clinical Research Organisation Sostana and Charité University Medicine, Berlin., Hellwig K; Department of Neurology, St. Josef-Hospital, Ruhr University Bochum, Bochum., Pache F; NeuroCure Clinical Research Center and Experimental and Clinical Research Center, Charité University Medicine, and Max Delbrueck Center for Molecular Medicine, Berlin.; Department of Neurology and Clinical and Experimental Multiple Sclerosis Research Center, Charité University Medicine, Berlin., Ruprecht K; Department of Neurology and Clinical and Experimental Multiple Sclerosis Research Center, Charité University Medicine, Berlin., Havla J; Institute of Clinical Neuroimmunology, Medical Campus Grosshadern, Ludwig Maximilians University, Munich., Krumbholz M; Institute of Clinical Neuroimmunology, Medical Campus Grosshadern, Ludwig Maximilians University, Munich., Kümpfel T; Institute of Clinical Neuroimmunology, Medical Campus Grosshadern, Ludwig Maximilians University, Munich., Aktas O; Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf., Hartung HP; Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf., Ringelstein M; Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf., Geis C; Department of Neurology, University Hospital Würzburg, Würzburg., Kleinschnitz C; Department of Neurology, University Hospital Würzburg, Würzburg., Berthele A; Department of Neurology, Technical University of Munich, Munich., Hemmer B; Department of Neurology, Technical University of Munich and Munich Cluster for Systems Neurology, Munich., Angstwurm K; Department of Neurology, University Hospital Regensburg, Regensburg., Stellmann JP; Institute for Neuroimmunology and MS and Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg., Schuster S; Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg., Stangel M; Clinical Neuroimmunology and Neurochemistry, Department of Neurology, Hannover Medical School, Hannover., Lauda F; Department of Neurology, University of Ulm, Ulm., Tumani H; Department of Neurology, University of Ulm, Ulm., Mayer C; Department of Neurology, Goethe University Frankfurt, Frankfurt., Zeltner L; Department of Neurology and Stroke and Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen., Ziemann U; Department of Neurology and Stroke and Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen., Linker R; Department of Neurology, Friedrich Alexander University Erlangen-Nuremberg, Erlangen., Schwab M; Hans Berger Department of Neurology, Jena University Hospital, Jena., Marziniak M; Department of Neurology, University of Münster, Münster., Then Bergh F; Department of Neurology, University of Leipzig, Leipzig., Hofstadt-van Oy U; Department of Neurology, Bayreuth Medical Center, Bayreuth., Neuhaus O; Department of Neurology, SRH Hospital Sigmaringen, Sigmaringen., Winkelmann A; Department of Neurology, University of Rostock, Rostock., Marouf W; Department of Neurology, HELIOS Hanse Hospital Stralsund, Stralsund., Faiss J; Department of Neurology, Asklepios Clinic Teupitz, Teupitz., Wildemann B; Molecular Neuroimmunology Group, Department of Neurology, University of Heidelberg, Heidelberg., Paul F; NeuroCure Clinical Research Center and Experimental and Clinical Research Center, Charité University Medicine, and Max Delbrueck Center for Molecular Medicine, Berlin.; Department of Neurology and Clinical and Experimental Multiple Sclerosis Research Center, Charité University Medicine, Berlin., Jarius S; Molecular Neuroimmunology Group, Department of Neurology, University of Heidelberg, Heidelberg., Trebst C; Department of Neurology, Hannover Medical School, Hannover, Germany.
Corporate Authors:
Neuromyelitis Optica Study Group
Source:
Annals of neurology [Ann Neurol] 2016 Feb; Vol. 79 (2), pp. 206-16. Date of Electronic Publication: 2015 Nov 26.
Publication Type:
Journal Article; Meta-Analysis
Language:
English
Journal Info:
Publisher: Wiley-Liss Country of Publication: United States NLM ID: 7707449 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1531-8249 (Electronic) Linking ISSN: 03645134 NLM ISO Abbreviation: Ann Neurol Subsets: MEDLINE
Imprint Name(s):
Publication: New York, NY : Wiley-Liss
Original Publication: Boston, Little, Brown.
MeSH Terms:
Neuromyelitis Optica/*therapy , Outcome Assessment, Health Care/*statistics & numerical data , Registries/*statistics & numerical data, Adult ; Female ; Germany ; Humans ; Male ; Middle Aged ; Neuromyelitis Optica/drug therapy ; Remission Induction ; Retrospective Studies
Comments:
Comment in: Ann Neurol. 2016 Feb;79(2):204-5. doi: 10.1002/ana.24557. (PMID: 26575334)
Contributed Indexing:
Investigator: P Albrecht; I Ayzenberg; F Bischof; T Böttcher; J Brettschneider; M Buttmann; B Ettrich; A Gass; K Guthke; F Hoffmann; M Kaste; P Kermer; P Kern; W Köhler; E Kolesilova; S Langel; M Liebetrau; A Melms; I Metz; C Münch; S Niehaus; H Pellkofer; A Riedlinger; L Röpke; P Rommer; C Ruschil; S Schippling; M Stoppe; J Tünnerhoff; C Veauthier; A Walter; KP Wandinger; MS Weber; R Weissert; C Wilke; K Young; C Zentner; U Zettl
Entry Date(s):
Date Created: 20151106 Date Completed: 20160617 Latest Revision: 20220408
Update Code:
20250114
DOI:
10.1002/ana.24554
PMID:
26537743
Database:
MEDLINE

Weitere Informationen

Objective: Neuromyelitis 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.
Methods: A 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.
Results: A 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).
Interpretation: Particularly myelitis and bilateral optic neuritis have poor remission rates. Escalation of attack therapy improves outcome. PE/IA may increase recovery in isolated myelitis.
(© 2015 American Neurological Association.)