Predictors of outcome after a first attack of Neuromyelitis Optica
ECTRIMS Online Library. Guillaume M. Oct 11, 2018; 231960
Maxime Guillaume
Maxime Guillaume
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Abstract: 211

Type: Scientific Session

Abstract Category: Clinical aspects of MS - Neuro-ophthalmology

Background: Few studies have assessed the predictive factors of recovery after attacks of Neuromyelitis Optica.
Objective: To define prognosis factors based on the clinical outcome 6 months after a first attack of neuromyelitis optica.
Method: We reviewed 438 subjects registered in the NOMADMUS cohort. To avoid effects of maintenance therapy, we only included the first attack for each clinical core localization. Subjects fulfilled the 1999, 2006 or 2015 criteria with assessed status for AQP4 or MOG antibodies. The primary judgement criteria was the EDSS score at 6 month follow-up. We classified the subjects into 3 groups depending on evolution: non response (NR), complete response (CR) and partial response (PR).
Results: We included 214 attacks for 188 subjects. Methylprednisolone represented 73% of all treatment lines, followed by Plasmatic Exchanges (25%) with a median onset at 9 days after the first symptoms. CR was reached in 16,8% (n=36), PR in 60,7% (n=130) and NR in 22,4% (n=48). Univariate analysis found that the positivity of AQP4-IgG (p=0,008) or the number of attacks during the following year (p=0,0002) was associated with a poor recovery, whereas MOG-IgG (p=0,00009) or a second treatment line (p=0,03) was of good prognosis. A second definition was used as follows: good responders if EDSS decreased of ≥ 2 points for an initial score ≥ 3 and 1 point if < 3, and poor responders if the EDSS decreased without reaching these thresholds. According to it, 62.5% were good responders, 15,4% poor responders and 22.4% stayed NR. The same predictors were found excepted for the second treatment line.
Conclusion: Actual treatment strategies lead to a strong disability improvement in a majority of patient. The presence of AQP4-IgG could confer a poor prognosis contrary to MOG-IgG which seems related to a better outcome.
Disclosure: Maxime Guillaume : nothing to disclose.
Romain Marignier : no disclosure related to this work.
Hélène Zéphir : no disclosure related to this work.
Elisabeth Maillard : no disclosure related to this work.
Bertrand Bourre : no disclosure related to this work.
Mickael Cohen : no disclosure related to this work.
Christine Lebrun-Frenay : no disclosure related to this work.
Bertrand Audouin : no disclosure related to this work.
Caroline Papeix : no disclosure related to this work.
Jonathan Ciron : no disclosure related to this work.
Nicolas Collongues : no disclosure related to this work.
Anne Kerbrat : no disclosure related to this work.
Laure Michel : no disclosure related to this work.

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