PT  - JOURNAL ARTICLE
AU  - Jan-Patrick Stellmann
AU  - Markus Krumbholz
AU  - Tim Friede
AU  - Anna Gahlen
AU  - Nadja Borisow
AU  - Katrin Fischer
AU  - Kerstin Hellwig
AU  - Florence Pache
AU  - Klemens Ruprecht
AU  - Joachim Havla
AU  - Tania Kümpfel
AU  - Orhan Aktas
AU  - Hans-Peter Hartung
AU  - Marius Ringelstein
AU  - Christian Geis
AU  - Christoph Kleinschnitz
AU  - Achim Berthele
AU  - Bernhard Hemmer
AU  - Klemens Angstwurm
AU  - Kim Lea Young
AU  - Simon Schuster
AU  - Martin Stangel
AU  - Florian Lauda
AU  - Hayrettin Tumani
AU  - Christoph Mayer
AU  - Lena Zeltner
AU  - Ulf Ziemann
AU  - Ralf Andreas Linker
AU  - Matthias Schwab
AU  - Martin Marziniak
AU  - Florian Then Bergh
AU  - Ulrich Hofstadt-van Oy
AU  - Oliver Neuhaus
AU  - Uwe Zettl
AU  - Jürgen Faiss
AU  - Brigitte Wildemann
AU  - Friedemann Paul
AU  - Sven Jarius
AU  - Corinna Trebst
AU  - Ingo Kleiter
ED  - ,
TI  - Immunotherapies in neuromyelitis optica spectrum disorder: efficacy and predictors of response
AID  - 10.1136/jnnp-2017-315603
DP  - 2017 Aug 01
TA  - Journal of Neurology, Neurosurgery & Psychiatry
PG  - 639--647
VI  - 88
IP  - 8
4099  - http://jnnp.bmj.com/content/88/8/639.short
4100  - http://jnnp.bmj.com/content/88/8/639.full
SO  - J Neurol Neurosurg Psychiatry2017 Aug 01; 88
AB  - Objective To analyse predictors for relapses and number of attacks under different immunotherapies in patients with neuromyelitis optica spectrum disorder (NMOSD).Design 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.Results 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-β (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-β, 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).Conclusions Age, antibody status and possibly previous attacks predict further attacks in patients treated for NMOSD. Azathioprine and rituximab are superior to interferon-β.