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Clinical and therapeutic predictors of relapse and disability outcomes in neuromyelitis optica spectrum disorder
Author(s): ,
A. Kunchok
Affiliations:
Neurology
,
C. Malpas
Affiliations:
Royal Melbourne Hospital, The University of Melbourne, Melbourne, VIC, Australia
,
D. Horakova
Affiliations:
Charles University in Prague and General University Hospital, Prague, Czech Republic
,
E. Havrdova
Affiliations:
Charles University in Prague and General University Hospital, Prague, Czech Republic
,
R. Alroughani
Affiliations:
Amiri Hospital, Sharq, Kuwait
,
M. Terzi
Affiliations:
Mayis University, Medical Faculty, Samsun, Turkey
,
B. Yamout
Affiliations:
American University of Beirut Medical Center, Beirut, Lebanon
,
R. Karabudak
Affiliations:
Hacettepe University Faculty of Medicine, Ankara
,
C. Boz
Affiliations:
KTU Medical Faculty Farabi Hospital, Trabzon
,
S. Ozakbas
Affiliations:
Dokuz Eylul University, Izmir, Turkey
,
J. Olascoaga
Affiliations:
Biodonostia Health Research Institute, San Sebastian, Spain
,
M. Simo
Affiliations:
Semmelweis University, Budapest, Hungary
,
F. Granella
Affiliations:
University of Parma, Parma, Italy
,
P. McCombe
Affiliations:
Royal Brisbane Hospital, Brisbane, QLD, Australia
,
T. Csepany
Affiliations:
University of Debrecen, Debrecen, Hungary
,
R. Bergamaschi
Affiliations:
IRCCS Mondino Foundation, Pavia, Italy
,
Y. Fragoso
Affiliations:
Universidade Metropolitana de Santos, Santos, Brazil
,
T. Al-Harbi
Affiliations:
King Fahad Specialist Hospital Dammam, Khobar, Saudi Arabia
,
R. Turkoglu
Affiliations:
Haydarpasa Numune Training and Research Hospital, Instanbul, Turkey
,
J. Lechner-Scott
Affiliations:
John Hunter Hospital, Newcastle, NSW, Australia
,
G. Laureys
Affiliations:
Universitary Hospital Ghent, Ghent, Belgium
,
E. Pucci
Affiliations:
UOC Neurologia, Macerata
,
P. Sola
Affiliations:
Azienda Ospedaliera Universitaria, Modena, Italy
,
D. Ferraro
Affiliations:
Azienda Ospedaliera Universitaria, Modena, Italy
,
A. Altintas
Affiliations:
Istanbul University Cerrahpasa School of Medicine, Instanbul, Turkey
,
F. Grand`Maison
Affiliations:
Neuro Rive-Sud, Quebec, QC, Canada
,
G. Izquierdo
Affiliations:
Hospital Universitario Virgen Macarena
,
S. Eichau
Affiliations:
Universitario Virgen Macarena, Sevilla, Spain
,
A. Lugaresi
Affiliations:
Department of Biomedical and Neuromotor Science, University of Bologna, Bologna, Italy
,
M. Marriott
Affiliations:
Royal Melbourne Hospital, The University of Melbourne, Melbourne, VIC, Australia
,
I. Kister
Affiliations:
New York University Langone Medical Center, Multiple Sclerosis Comprehensive Care Center, New York, NY, United States
,
H. Butzkueven
Affiliations:
Monash University, Melbourne, VIC, Australia
,
T. Kalincik
Affiliations:
Royal Melbourne Hospital, The University of Melbourne, Melbourne, VIC, Australia
MSBase study group
MSBase study group
Affiliations:
ECTRIMS Online Library. Kunchok A. Oct 12, 2018; 228822
Amy Kunchok
Amy Kunchok
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Abstract
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Abstract: P980

Type: Poster Sessions

Abstract Category: Clinical aspects of MS - MS Variants

Introduction: Neuromyelitis optica spectrum disorder (NMOSD) is a central nervous system autoimmune inflammatory condition associated with aquaporin-4-immunglobulin antibodies which results in demyelination. Understanding clinical and therapeutic predictors of relapses can aid management and prognostication of this disease
Aim: To evaluate the effect of clinical and therapeutic predictors on risk of relapse and change in disability in NMOSD
Methods: This MSBase cohort study of NMOSD patients (n=399) examined predictors of relapse in a Anderson-Gill survival model and change in expanded disability status score (EDSS) in a mixed effects model. A secondary analysis was conducted in the NMO-antibody positive subgroup (≥1 core region affected: spinal cord, optic nerve or brainstem, n=202).
Results: Age (HR=0.82 per decade, p=0.003), disease duration (HR=0.95 per year, p=0.02), spinal cord onset (HR=0.6, p=0.007), brainstem onset (p=0.53, p=0.009) and treatment with azathioprine (HR=0.51, p< 0.001), mycophenolate mofetil (HR=0.24, p=0.016) were associated with a reduced risk of relapse in NMOSD. Treatment with glatiramer acetate (HR=1.82, p=0.028), interferon-β (HR=1.57, p=0.013) and acute therapies - corticosteroids (HR=1.87, p < 0.001), intravenous immunoglobulin (HR=3.49, p=0.001) were associated with an increased risk of relapse. In the NMO-antibody positive subgroup, similar treatment effects on the risk of relapse were seen for azathioprine, mycophenolate mofetil, glatiramer acetate, corticosteroids and intravenous immunoglobulin. Age (p< 0.001), disease duration (p< 0.001), glatiramer acetate (p=0.001), and therapies used in acute relapses - cyclophosphamide (p=0.01), intravenous immunoglobulin (p=0.001) and plasma exchange (p< 0.001) were associated with a more pronounced increase in EDSS in the NMOSD cohort. Optic nerve onset (p=0.048), proportion of time pregnant (p=0.021) and treatment with azathioprine (p< 0.001), mycophenolate mofetil (p=0.043) and rituximab (p=0.029) - were associated with a slower increase in EDSS in the NMOSD cohort. The immunotherapies and age and disease duration showed similar associations in the NMO-antibody positive subgroup.
Conclusion: Treatment with azathioprine, rituximab and mycophenolate mofteil are associated with a slower increase in EDSS in NMOSD and a lower risk of relapses. The risk of relapses declines and accumulation of disability increases with age and disease duration in NMOSD.
Disclosure: Amy Kunchok received research support from Biogen.
Charles Malpas - nothing to disclose
Dana Horakova received speaker honoraria and consulting fees from Biogen, Merck , Teva and Novartis, as well as support for research activities from Biogen and research grants from Charles University in Prague [PRVOUK-P26/LF1/4], Czech Minsitry of Education [PROGRES Q27/LF1] and Czech Ministry of Health [NT13237-4/2012].
Eva Kubala Havrdova received speaker honoraria and consultant fees from Actelion, Biogen, Celgene, Merck, Novartis, Roche, Sanofi and Teva, and support for research activities from Czech Ministry of Education [project Progres Q27/LF1].
Raed Alroughani received honoraria as a speaker and for serving on scientific advisory boards from Bayer, Biogen, GSK, Merck, Novartis, Roche and Sanofi-Genzyme.
Murat Terzi received travel grants from Novartis, Bayer-Schering, Merck and Teva; has participated in clinical trials by Sanofi Aventis, Roche and Novartis.
Bassem Yamout did not declare any competing interests.
Rana Karabudak did not declare any competing interests.
Cavit Boz received conference travel support from Biogen, Novartis, Bayer-Schering, Merck and Teva; has participated in clinical trials by Sanofi Aventis, Roche and Novartis.
Serkan Ozakbas did not declare any competing interests.
Javier Olascoaga serves on scientific advisory boards for Biogen, Novartis, Sanofi and Roche; has received speaker honoraria from Almirall, Biogen, Bayer, Sanofi, Merck, Novartis and Roche and research grants from Biogen, Merck , Novartis and Teva.
Magdolna Simo received speaker honoraria from Novartis, Biogen, Bayer Schering; congress/travel compensation from Teva, Biogen, Merck , Bayer Schering.
Franco Granella received research grant from Biogen, served on scientific advisory boards for Biogen, Novartis, Merck, and Sanofi-Aventis and received funding for travel and speaker honoraria from Biogen, Merck, Sanofi-Aventis, and Almirall.
Pamela McCombe received honoraria and consulting fees from Novartis, Bayer Schering and Sanofi and travel grants from Novartis, Biogen and Bayer Schering.
Tunde Csepany received speaker honoraria/ conference travel support from Bayer Schering, Biogen, Merck , Novartis and Teva.
Roberto Bergamaschi received speaker honoraria from Bayer Schering, Biogen, Genzyme, Merck , Novartis, Sanofi-Aventis, Teva; research grants from Bayer Schering, Biogen, Merck , Novartis, Sanofi-Aventis, Teva; congress and travel/accommodation expense compensations by Almirall, Bayer Schering, Biogen, Genzyme, Merck , Novartis, Sanofi-Aventis, Teva.
Yara Fragoso received honoraria as a consultant on scientific advisory boards by Novartis, Teva, Roche and Sanofi-Aventis and compensation for travel from Novartis, Biogen, Sanofi Aventis, Teva, Roche and Merck.
Talal Al-Harbi did not declare any competing interests.
Recai Turkoglu did not declare any competing interests.
Jeannette Lechner-Scott accepted travel compensation from Novartis, Biogen and Merck. Her institution receives the honoraria for talks and advisory board commitment from Bayer Health Care, Biogen, Genzyme Sanofi, Merck, Novartis and Teva, has been involved in clinical trials with Biogen, Novartis and Teva.
Guy Laureys did not declare any competing interests.
Eugenio Pucci served on scientific advisory boards for Merck, Genzyme and Biogen; he has received honoraria and travel grants from Sanofi Aventis, Novartis, Biogen, Merck, Genzyme and Teva; he has received travel grants and equipment from "Associazione Marchigiana Sclerosi Multipla e altre malattie neurologiche".
Patrizia Sola served on scientific advisory boards for Biogen Idec and TEVA, she has received funding for travel and speaker honoraria from Biogen Idec, Merck , Teva, Sanofi Genzyme, Novartis and Bayer and research grants for her Institution from Bayer, Biogen, Merck , Novartis, Sanofi, Teva.
Diana Ferraro received travel grants and/or speaker honoraria from Merck, TEVA,†Novartis, Biogen and Sanofi-Genzyme.
Ayse Altintas received personal fees and speaker honoraria from Teva, Merck, Biogen - Gen Pharma, Roche, Novartis, Bayer, Sanofi-Genzyme; received travel and registration grants from Merck, Biogen - Gen Pharma, Roche, Sanofi-Genzyme and Bayer.
Aysun Soysal did not declare any competing interests.
Francois Grand´Maison received honoraria or research funding from Biogen, Genzyme, Novartis, Teva Neurosciences, Mitsubishi and ONO Pharmaceuticals.
Guillermo Izquierdo received speaking honoraria from Biogen, Novartis, Sanofi, Merck, Roche, Almirall and Teva.
Sara Eichau did not declare any competing interests.
Alessandra Lugaresi is a Bayer, Biogen, Genzyme, Merck Advisory Board Member. She received travel grants and honoraria from Roche, Bayer, Biogen, Merck, Novartis, Sanofi, Teva and Fondazione Italiana Sclerosi Multipla (FISM). Her institution received research grants from Bayer, Biogen, Merck, Novartis, Sanofi , Teva and Fondazione Italiana Sclerosi Multipla (FISM).
Mark Marriott - nothing to disclose
Ilya Kister served on scientific advisory board for Biogen and received research support from Guthy-Jackson Charitable Foundation, National Multiple Sclerosis Society, Biogen, , and Novartis.
Helmut Butzkueven served on scientific advisory boards for Biogen, Novartis and Sanofi-Aventis and has received conference travel support from Novartis, Biogen and Sanofi Aventis. He serves on steering committees for trials conducted by Biogen and Novartis, and has received research support from Merck , Novartis and Biogen.
Tomas Kalincik served on scientific advisory boards for Roche, Genzyme-Sanofi, Novartis, Merck and Biogen, steering committee for Brain Atrophy Initiative by Genzyme, received conference travel support and/or speaker honoraria from WebMD Global, Novartis, Biogen, Genzyme-Sanofi, Teva, BioCSL and Merck and received research support from Biogen.

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