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Escalation of Therapy in Neuromyelitis Optica Attacks

Do multiple courses of treatment affect outcomes?

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Escalation of attack therapy improves outcomes for patients with neuromyelitis optica (NMO), according to a study of 871 attacks in 185 patients with NMO. Researchers found:

• Therapies were:

◊ High-dose intravenous steroids (HD-S)

◊ Plasma exchange (PE)

◊ Immunoadsorption (IA)

◊ Other

◊ Unknown

• First treatment courses led to complete remission (CR) in 19.1% of attacks, partial remission in 64.5%, and no remission in 16.4%.

• Second, third, fourth, and fifth treatment courses were given in 28.2%, 7.1%, 1.4%, and 0.5% of attacks, respectively.

• Escalation of attack therapy significantly improved outcomes.

• Remission rates were higher for isolated optic neuritis vs isolated myelitis, and for unilateral vs bilateral optic neuritis.

• Isolated myelitis responded better to PE/IA therapy than to HD-S as first treatment course.

• In multivariate analysis, predictors of CR were age, presence of myelitis, CR from previous attack, and first-line PE/IA vs HD-S.

Citation: Kleiter I, Gahlen A, Borisow N, et al. Neuromyelitis optica: Evaluation of 871 attacks and 1153 treatment courses. [Published online ahead of print November 4, 2015]. Ann Neurol. doi: 10.1002/ana.24554.

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