Prognostic factor for therapeutic response of attacks in anti-AQP4, anti-MOG seropositive and NMO seronegative patients
ECTRIMS Online Library. Collongues N. Oct 26, 2017; 199958
Nicolas Collongues
Nicolas Collongues
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Abstract: P303

Type: Poster

Abstract Category: Clinical aspects of MS - 2 MS Variants

Background: Few data are available to define the best therapeutic strategy in treating attacks of NMO.
Objective: To define predictive factors for therapeutic response of the attacks in patients seropositive for anti-AQP4, anti-MOG or seronegative NMO.
Methods: We collected data from 5 referral centers included in the NOMADMUS project in France. Patients included should fulfill either NMOSD 2015 criteria or be positive for anti-AQP4/anti-MOG, be all free of any previous immunosuppressive drugs at the time of attack. To prevent biases, we considered only the very first attack for a given topography and the first treatment should be initiated during the first month. Therapeutic response was assessed using the EDSS score and was defined at 6 months by a complete regression of the symptoms (CR), a partial regression (PR) or the absence of response (NR).
Results: Seventy five patients were identified corresponding to 82 attacks. Mean age of first attack was 37 years including 43 myelitis (TM), 27 optic neuritis (ON), 8 ON+TM, one brainstem syndrome (BS), one ADEM and 2 BS+TM. Anti-AQP4 antibodies were found in 53 attacks and anti-MOG in 18 whereas 11 attacks were seronegative. Patients received the first treatment for their attack in a mean time of 13.7±19 days consisting in intravenous high dose steroid in 79 attacks at a mean dose of 5±2.8 grams. Second line of treatment was made in a mean time of 13.3±13.6 days following first line with steroïds in 5 attacks, plasma exchanges in 24 attacks and IgIV in one. A third therapeutic line was proposed for 5 attacks. A CR was observed in 17 (20%) attacks, a PR in 45 (55%) and NR was observed in 16 (25%). In the univariate analysis, positivity for anti-AQP4 antibodies and the long delay between the first and the second line of treatment were two prognostic factors associated to a poor recovery. The dose of steroids and time to first line of treatment did not influence the recovery. No factor was identified independently in the multivariate analysis, probably due to the insufficient number of patients.
Conclusion: In this previously untreated population of seropositive AQP4+, MOG+ and seronegative NMO patients, AQP4-Ab positive status and delayed to second line treatment were both associated to poor recovery.
R.M. serves on scientific advisory board for MedImmune and has received funding for travel and honoraria from Biogen Idec, Merck Serono, Novartis, Sanofi- Genzyme, Roche and Teva, with no relation to this study.
N.C. has received funding for travel and honoraria from Biogen Idec, Merck Serono, Novartis, Sanofi- Genzyme, Roche and Teva, with no relation to this study.
M.C. reports participation to advisory boards for Biogen, Novartis, Roche and
Ad Scientam, with no relation to this study.
E.M. reports participation to meetings and advisory boards for Biogen, Genzyme, Merck, Novartis, Roche and Teva, with no relation to the submitted work.
J.C received consulting and lecture fees, travel grants from Biogen, Novartis, Genzyme, Teva Pharmaceuticals, Merck Serono and Roche, with no relation with the submitted work.
A.K nothing to disclose

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