Plasma exchange: an effective add-on treatment of optic neuritis in neuromyelitis optica spectrum disorders

Background: Myelin oligodendrocyte glycoprotein (anti-MOG) antibody was reported in anti-aquaporin-4 (anti-AQP4) seronegative neuromyelitis optica spectrum disorders (NMOSD) patients. Objectives: To describe clinical phenotypes associated with anti-MOG. Methods: Seventy consecutive Thai patients with inflammatory idiopathic demyelinating central nervous system disorders (IIDCD) who were previously anti-AQP4 seronegative were tested for anti-MOG. Results: Anti-MOG was positive in six patients, representing 20.7% of the IIDCD anti-AQP4 seronegative patients with a non-multiple sclerosis phenotype, and most had relapses. All first presented with optic neuritis with good visual recovery after treatment. Conclusions: Anti-MOG positive patients may have manifestations that mimic NMOSD but differ in their course and prognosis from anti-AQP4 positive NMOSD.

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Anti-B-cell therapy in patients with neuromyelitis optica spectrum disorders

Neurology neuropsychiatry Psychosomatics ◽

10.14412/2074-2711-2021-4-18-24 ◽

2021 ◽

Vol 13 (4) ◽

pp. 18-24

Author(s):

S. V. Kotov ◽

E. S. Novikova ◽

A. S. Kotov

Keyword(s):

Optic Neuritis ◽

Relapse Rate ◽

Neuromyelitis Optica ◽

Clinical Manifestations ◽

Treatment Protocol ◽

Transverse Myelitis ◽

Neuromyelitis Optica Spectrum Disorders ◽

Intravenous Infusions ◽

Annualized Relapse Rate ◽

Spectrum Disorders

Neuromyelitis optica spectrum disorders (NMOSDs) are a group of central nervous system autoimmune diseases characterized by similar clinical manifestations, optic neuritis, and transverse myelitis being the most frequent among them. In most cases, the pathogenesis of NMOSDs is associated with autoantibodies to aquaporin-4 (AQP4-IgG). However, AQP4-IgG is not detected in at least 10-20% of patients with NMOSDs. In this subgroup and in patients with isolated transverse myelitis or optic neuritis, IgG antibodies to myelin oligodendrocyte glycoprotein (MOG-IgG) were detected. Patients seronegative for both AQP4-IgG and MOG-IgG have also been described.Objective: to evaluate rituximab (RTX) effectiveness in preventing relapses and disability in patients with NMOSDs.Patients and methods. The study included 27 patients with NMOSDs (9 men and 18 women) aged 20-51 years who received RTX in 2019-2021. The treatment protocol included intravenous infusions of 1000 mg of RTX on the 1st and 15th days, the second and subsequent courses (maintenance therapy) - intravenous infusions of 1000 mg of RTX once every six months. Treatment effectiveness was assessed by the average annualized relapse rate, the median changes of the Expanded Disability Status Scale (EDSS), and based on the magnetic resonance imaging (MRI) changes.Results and discussion. The annualized relapse rate at baseline and 18 months after the start of treatment was: all patients (n=27) — 0.6±0.3 and 0.07±0.27(p<0.0001); AQP4-IgG+ patients (n=6) — 1.1±0.9 and 0.17±0.41 (p=0.028); MOG-IgG+ patients (n=14) — 0.4±0.3 and 0.07±0.28(p=0.001); AQP4-IgG-, MOG-IgG-patients (n=7) — 0.8±0.4 and 0.0±0.0 (p=0.018). The EDSSscore at baseline and 18months after the start of treatment was: all patients — 4.5 [3.25; 6.0] and 4.0 [3.0; 5.75] (p=0.679); AQP4-IgG+ — 3.5 [2.625; 4.75] and 3.5 [2.5; 4.5] (p=0.869); MOG-IgG+ - 5.5[3.75; 6.5] and 5.5[2.75; 6.25] (p=0.465); AQP4-IgG-, MOG-IgG- - 4.0[3.75; 5.25] and 3.5[3.0; 3.5] (p=0.043). We observed two clinical relapses during the study period: one in an AQP4-IgG+ male and another one in a MOG-IgG+ woman. There was a significant decrease in the annualized relapse rate in all groups. The disability indicator did not increase during the study period, and in AQP4-IgG and MOG-IgG seronegative patients, it slightly but significantly decreased. Brain and spinal cord MRI monitoring during the treatment period revealed new active foci only in two patients with clinical relapses.Conclusion. RTX treatment in NMOSDs is reasonably efficient and safe, but with the obligatory prior patient evaluation and monitoring of treatment results.

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Maintenance therapeutic plasma exchange in patients with neuromyelitis optica spectrum disorders

10.26226/morressier.59a3e8b3d462b8028d894157 ◽

2017 ◽

Author(s):

Irena P. Dujmovic Basuroski

Keyword(s):

Plasma Exchange ◽

Neuromyelitis Optica ◽

Therapeutic Plasma Exchange ◽

Neuromyelitis Optica Spectrum Disorders ◽

Spectrum Disorders

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Differences in clinical features between optic neuritis in neuromyelitis optica spectrum disorders and in multiple sclerosis

Multiple Sclerosis Journal - Experimental Translational and Clinical ◽

10.1177/2055217318791196 ◽

2018 ◽

Vol 4 (3) ◽

pp. 205521731879119 ◽

Cited By ~ 5

Author(s):

Jindapa Srikajon ◽

Sasitorn Siritho ◽

Chanon Ngamsombat ◽

Naraporn Prayoonwiwat ◽

Niphon Chirapapaisan ◽

...

Keyword(s):

Multiple Sclerosis ◽

Visual Acuity ◽

Optic Neuritis ◽

Neuromyelitis Optica ◽

Retrospective Chart Review ◽

Visual Outcome ◽

Neuromyelitis Optica Spectrum Disorders ◽

Fiber Layer ◽

Spectrum Disorders

Background Optic neuritis (ON) is one of the common manifestations both in neuromyelitis-optica spectrum disorders (NMOSD) and in multiple sclerosis (MS). Objectives The objective of this paper is to compare clinical presentations, laboratories and imaging findings in ON associated with MS and NMOSD. Methods A retrospective chart review was performed in patients presenting with ON in 59 NMOSD patients with 72 eyes’ involvement and 163 ON attacks, and 20 MS patients with 23 eyes’ involvement and 36 ON attacks. Results ON-NMOSD patients had recurrent ON more often and tended to have simultaneous bilateral ON involvement at their first ON attack. Individuals with ON-NMOSD revealed worse visual acuity at first ON attacks and also had poorer long-term visual outcome than those with ON-MS, with nearly half of ON-NMOSD patients still having LogMAR visual acuity ≥1 at their last follow-up ( p = 0.035). Significant thinner average retinal nerve fiber layer thickness was found in the ON-NMOSD group. We found no significant differences in segmentation location of the optic nerve lesions and the length of involvement between the two groups. Conclusions It was difficult to completely differentiate ON-NMOSD from ON-MS. ON-NMOSD patients, however, tended to have simultaneous bilateral ON involvement and poorer long-term visual outcome than individuals with ON-MS.

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HLA genotype-clinical phenotype correlations in multiple sclerosis and neuromyelitis optica spectrum disorders based on Japan MS/NMOSD Biobank data

Scientific Reports ◽

10.1038/s41598-020-79833-7 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Mitsuru Watanabe ◽

Yuri Nakamura ◽

Shinya Sato ◽

Masaaki Niino ◽

Hikoaki Fukaura ◽

...

Keyword(s):

Multiple Sclerosis ◽

Spinal Cord ◽

Optic Neuritis ◽

Neuromyelitis Optica ◽

Clinical Phenotype ◽

Multivariable Analysis ◽

Neuromyelitis Optica Spectrum Disorders ◽

Onset Age ◽

High Tendency ◽

Spectrum Disorders

AbstractHLA genotype-clinical phenotype correlations are not established for multiple sclerosis (MS) and neuromyelitis optica spectrum disorders (NMOSD). We studied HLA-DRB1/DPB1 genotype–phenotype correlations in 528 MS and 165 NMOSD cases using Japan MS/NMOSD Biobank materials. HLA-DRB1*04:05, DRB1*15:01 and DPB1*03:01 correlated with MS susceptibility and DRB1*01:01, DRB1*09:01, DRB1*13:02 and DPB1*04:01 were protective against MS. HLA-DRB1*15:01 was associated with increased optic neuritis and cerebellar involvement and worsened visual and pyramidal functional scale (FS) scores, resulting in higher progression index values. HLA-DRB1*04:05 was associated with younger onset age, high visual FS scores, and a high tendency to develop optic neuritis. HLA-DPB1*03:01 increased brainstem and cerebellar FS scores. By contrast, HLA-DRB1*01:01 decreased spinal cord involvement and sensory FS scores, HLA-DRB1*09:01 decreased annualized relapse rate, brainstem involvement and bowel and bladder FS scores, and HLA-DRB1*13:02 decreased spinal cord and brainstem involvement. In NMOSD, HLA-DRB1*08:02 and DPB1*05:01 were associated with susceptibility and DRB1*09:01 was protective. Multivariable analysis revealed old onset age, long disease duration, and many relapses as independent disability risks in both MS and NMOSD, and HLA-DRB1*15:01 as an independent risk only in MS. Therefore, both susceptibility and protective alleles can influence the clinical manifestations in MS, while such genotype–phenotype correlations are unclear in NMOSD.

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