George Tackley1, Fanny O'Brien2, João Rocha1, Mark Woodhall1, Patrick Waters1, Saleel Chandratre3, Christopher Halfpenny4, Cheryl Hemingway5, Evangeline Wassmer6, Warren Wasiewski2, Maria Isabel Leite1, Jacqueline Palace7. 1. Nuffield Department of Clinical Neurosciences, Oxford University, John Radcliffe Hospital, Oxford, UK. 2. Alexion Pharmaceutical, 55 Cambridge Parkway (Suite 800), Cambridge, MA 02142, USA. 3. Department of Paediatric Neurology, John Radcliffe Hospital, Oxford, UK. 4. Department of Neurology, Southampton General Hospital, Southampton, UK. 5. Department of Neurology, Great Ormond Street Hospital, London, UK. 6. Department of Neurology, Birmingham Children's Hospital, Birmingham, UK. 7. Nuffield Department of Clinical Neurosciences, Oxford University, John Radcliffe Hospital, Oxford, UK. Electronic address: jacqueline.palace@ndcn.ox.ac.uk.
Abstract
OBJECTIVE: Neuromyelitis optica (NMO) is a rare antibody-mediated CNS disease characterised by disabling relapses leading to high morbidity and mortality. Understanding relapse activity and severity is important for treatment decisions and clinical trial design. We assessed (1) whether clinical and demographic factors associate with different relapse rates and (2) the relative impact of immunosuppressive treatments on relapse rates and on attack-related residual disability. METHODS: Clinical, demographic and treatment data were prospectively collected from 79 consecutive aquaporin 4 antibody positive patients seen in the nationally commissioned Oxford NMO service. The influence of clinical features on annualised relapse rates (using multiple regression) and the effect of immunosuppression on relapse-associated residual disability for transverse myelitis and optic neuritis attacks (using a mixed effect model) were analysed. RESULTS: The mean annualised relapse rate was 0.93. Relapse rates were significantly higher in Afro-Caribbeans, children and in those of shorter disease duration. Relapse rates reduced on treatment (from 0.87 to 0.42). Delay to first treatment did not influence eventual on-treatment relapse rate. Immunosuppressive treatment significantly reduced the residual disability from ON (p<0.01), and TM (p=0.029) attacks. CONCLUSIONS: Relapse rates in NMO are influenced by multiple factors, including age, ethnicity and disease duration. Current immunosuppressive treatments reduce but do not abolish relapses, however, they appear to additionally lessen the chronic disabling effect of a relapse.
OBJECTIVE:Neuromyelitis optica (NMO) is a rare antibody-mediated CNS disease characterised by disabling relapses leading to high morbidity and mortality. Understanding relapse activity and severity is important for treatment decisions and clinical trial design. We assessed (1) whether clinical and demographic factors associate with different relapse rates and (2) the relative impact of immunosuppressive treatments on relapse rates and on attack-related residual disability. METHODS: Clinical, demographic and treatment data were prospectively collected from 79 consecutive aquaporin 4 antibody positive patients seen in the nationally commissioned Oxford NMO service. The influence of clinical features on annualised relapse rates (using multiple regression) and the effect of immunosuppression on relapse-associated residual disability for transverse myelitis and optic neuritis attacks (using a mixed effect model) were analysed. RESULTS: The mean annualised relapse rate was 0.93. Relapse rates were significantly higher in Afro-Caribbeans, children and in those of shorter disease duration. Relapse rates reduced on treatment (from 0.87 to 0.42). Delay to first treatment did not influence eventual on-treatment relapse rate. Immunosuppressive treatment significantly reduced the residual disability from ON (p<0.01), and TM (p=0.029) attacks. CONCLUSIONS: Relapse rates in NMO are influenced by multiple factors, including age, ethnicity and disease duration. Current immunosuppressive treatments reduce but do not abolish relapses, however, they appear to additionally lessen the chronic disabling effect of a relapse.
Authors: Jan-Patrick Stellmann; Markus Krumbholz; Tim Friede; Anna Gahlen; Nadja Borisow; Katrin Fischer; Kerstin Hellwig; Florence Pache; Klemens Ruprecht; Joachim Havla; Tania Kümpfel; Orhan Aktas; Hans-Peter Hartung; Marius Ringelstein; Christian Geis; Christoph Kleinschnitz; Achim Berthele; Bernhard Hemmer; Klemens Angstwurm; Kim Lea Young; Simon Schuster; Martin Stangel; Florian Lauda; Hayrettin Tumani; Christoph Mayer; Lena Zeltner; Ulf Ziemann; Ralf Andreas Linker; Matthias Schwab; Martin Marziniak; Florian Then Bergh; Ulrich Hofstadt-van Oy; Oliver Neuhaus; Uwe Zettl; Jürgen Faiss; Brigitte Wildemann; Friedemann Paul; Sven Jarius; Corinna Trebst; Ingo Kleiter Journal: J Neurol Neurosurg Psychiatry Date: 2017-06-01 Impact factor: 10.154
Authors: Lawrence J Cook; John W Rose; Jessica S Alvey; Anna Marie Jolley; Renee Kuhn; Brie Marron; Melissa Pederson; Rene Enriquez; Jeff Yearley; Stephen McKechnie; May H Han; Anna J Tomczak; Michael Levy; Maureen A Mealy; Jessica Coleman; Jeffrey L Bennett; Ruth Johnson; Myka Barnes-Garcia; Anthony L Traboulsee; Robert L Carruthers; Lisa Eunyoung Lee; Julia J Schubert; Katrina McMullen; Ilya Kister; Zoe Rimler; Allyson Reid; Nancy L Sicotte; Sarah M Planchon; Jeffrey A Cohen; Diane Ivancic; Jennifer L Sedlak; Ilana Katz Sand; Pavle Repovic; Lilyana Amezcua; Ana Pruitt; Erika Amundson; Tanuja Chitnis; Devin S Mullin; Eric C Klawiter; Andrew W Russo; Claire S Riley; Kaho B Onomichi; Libby Levine; Katherine E Nelson; Nancy M Nealon; Casey Engel; Mason Kruse-Hoyer; Melanie Marcille; Leticia Tornes; Anne Rumpf; Angela Greer; Megan Kenneally Behne; Renee R Rodriguez; Daniel W Behne; Derek W Blackway; Brian Coords; Terrence F Blaschke; Judy Sheard; Terry J Smith; Jacinta M Behne; Michael R Yeaman Journal: Neurol Neuroimmunol Neuroinflamm Date: 2019-06-28
Authors: Edgar Carnero Contentti; Pablo A Lopez; Juan Pablo Pettinicchi; Juan Criniti; Agustín Pappolla; Jimena Miguez; Liliana Patrucco; Edgardo Carnero Contentti; Susana Liwacki; Verónica Tkachuk; María E Balbuena; Carlos Vrech; Norma Deri; Jorge Correale; Mariano Marrodan; María C Ysrraelit; Felisa Leguizamon; Geraldine Luetic; María L Menichini; Darío Tavolini; Carolina Mainella; Gisela Zanga; Marcos Burgos; Javier Hryb; Andrés Barboza; Luciana Lazaro; Ricardo Alonso; Nora Fernández Liguori; Débora Nadur; Aníbal Chercoff; Marina Alonso Serena; Alejandro Caride; Friedemann Paul; Juan I Rojas Journal: Mult Scler J Exp Transl Clin Date: 2021-08-20