Immunoadsorption as maintenance therapy for refractory neuromyelitis optica spectrum disorder
Background: Neuromyelitis optica spectrum disorder (NMOSD) is a rare relapsing autoimmune disease of the central nervous system, affecting mainly optic nerves and spinal cord. NMOSD pathophysiology is associated with anti-aquaporin-4 (AQP4) immunoglobulin G (IgG) autoantibodies. Rapid extracorporeal...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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SAGE Publishing
2023-02-01
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| Series: | Therapeutic Advances in Neurological Disorders |
| Online Access: | https://doi.org/10.1177/17562864221150314 |
| _version_ | 1811170417535090688 |
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| author | Franz Heigl Reinhard Hettich Cordula Fassbender Reinhard Klingel Erich Mauch Joachim Durner Rolf Kern Ingo Kleiter |
| author_facet | Franz Heigl Reinhard Hettich Cordula Fassbender Reinhard Klingel Erich Mauch Joachim Durner Rolf Kern Ingo Kleiter |
| author_sort | Franz Heigl |
| collection | DOAJ |
| description | Background: Neuromyelitis optica spectrum disorder (NMOSD) is a rare relapsing autoimmune disease of the central nervous system, affecting mainly optic nerves and spinal cord. NMOSD pathophysiology is associated with anti-aquaporin-4 (AQP4) immunoglobulin G (IgG) autoantibodies. Rapid extracorporeal elimination of autoantibodies with apheresis techniques, such as immunoadsorption (IA), was proven to be an effective treatment of NMOSD attacks. Data on the long-term use of IA to prevent attacks or progression of NMOSD are lacking. Objectives: The aim of this study was to evaluate efficacy and safety of maintenance IA for preventing recurrence of NMOSD attacks in patients refractory to other immunotherapies. Design: Case study. Methods: Retrospective analysis of two female patients with severe NMOSD refractory to conventional immunotherapies was performed. Both patients had responded to tryptophan IA (Tr-IA) as attack therapy and subsequently were treated with biweekly maintenance Tr-IA. Results: Patient 1 (AQP4-IgG seropositive, age 42 years) had 1.38 attacks of optic neuritis per year within 10.1 years before commencing regular Tr-IA. With maintenance Tr-IA for 3.1 years, one mild attack occurred, which was responsive to steroid pulse therapy. Expanded Disability Status Scale (EDSS) was stable at 5.0. Visual function score of the last eye improved from 3 to 1. Patient 2 (AQP4-IgG seronegative, age 43 years) experienced 1.7 attacks per year, mainly acute myelitis and optic neuritis, during the period of 10.0 years before the start of Tr-IA. During regular Tr-IA treatment, no further NMOSD attack occurred. The patient was clinically stable without any additional immunosuppressive treatment for 5.3 years. EDSS improved from 6.0 to 5.0, and the ambulation score from 7 to 1. Tolerability of Tr-IA was good in both patients. No serious adverse events occurred during long-term clinical trajectories. Conclusion: Tr-IA was well tolerated as maintenance treatment and resulted in clinical stabilization of two patients with highly active NMOSD, who were refractory to standard drug therapy. |
| first_indexed | 2024-04-10T16:56:27Z |
| format | Article |
| id | doaj.art-82ebb643861d4c8da2fff24162ac1e66 |
| institution | Directory Open Access Journal |
| issn | 1756-2864 |
| language | English |
| last_indexed | 2024-04-10T16:56:27Z |
| publishDate | 2023-02-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Therapeutic Advances in Neurological Disorders |
| spelling | doaj.art-82ebb643861d4c8da2fff24162ac1e662023-02-07T06:03:31ZengSAGE PublishingTherapeutic Advances in Neurological Disorders1756-28642023-02-011610.1177/17562864221150314Immunoadsorption as maintenance therapy for refractory neuromyelitis optica spectrum disorderFranz HeiglReinhard HettichCordula FassbenderReinhard KlingelErich MauchJoachim DurnerRolf KernIngo KleiterBackground: Neuromyelitis optica spectrum disorder (NMOSD) is a rare relapsing autoimmune disease of the central nervous system, affecting mainly optic nerves and spinal cord. NMOSD pathophysiology is associated with anti-aquaporin-4 (AQP4) immunoglobulin G (IgG) autoantibodies. Rapid extracorporeal elimination of autoantibodies with apheresis techniques, such as immunoadsorption (IA), was proven to be an effective treatment of NMOSD attacks. Data on the long-term use of IA to prevent attacks or progression of NMOSD are lacking. Objectives: The aim of this study was to evaluate efficacy and safety of maintenance IA for preventing recurrence of NMOSD attacks in patients refractory to other immunotherapies. Design: Case study. Methods: Retrospective analysis of two female patients with severe NMOSD refractory to conventional immunotherapies was performed. Both patients had responded to tryptophan IA (Tr-IA) as attack therapy and subsequently were treated with biweekly maintenance Tr-IA. Results: Patient 1 (AQP4-IgG seropositive, age 42 years) had 1.38 attacks of optic neuritis per year within 10.1 years before commencing regular Tr-IA. With maintenance Tr-IA for 3.1 years, one mild attack occurred, which was responsive to steroid pulse therapy. Expanded Disability Status Scale (EDSS) was stable at 5.0. Visual function score of the last eye improved from 3 to 1. Patient 2 (AQP4-IgG seronegative, age 43 years) experienced 1.7 attacks per year, mainly acute myelitis and optic neuritis, during the period of 10.0 years before the start of Tr-IA. During regular Tr-IA treatment, no further NMOSD attack occurred. The patient was clinically stable without any additional immunosuppressive treatment for 5.3 years. EDSS improved from 6.0 to 5.0, and the ambulation score from 7 to 1. Tolerability of Tr-IA was good in both patients. No serious adverse events occurred during long-term clinical trajectories. Conclusion: Tr-IA was well tolerated as maintenance treatment and resulted in clinical stabilization of two patients with highly active NMOSD, who were refractory to standard drug therapy.https://doi.org/10.1177/17562864221150314 |
| spellingShingle | Franz Heigl Reinhard Hettich Cordula Fassbender Reinhard Klingel Erich Mauch Joachim Durner Rolf Kern Ingo Kleiter Immunoadsorption as maintenance therapy for refractory neuromyelitis optica spectrum disorder Therapeutic Advances in Neurological Disorders |
| title | Immunoadsorption as maintenance therapy for refractory neuromyelitis optica spectrum disorder |
| title_full | Immunoadsorption as maintenance therapy for refractory neuromyelitis optica spectrum disorder |
| title_fullStr | Immunoadsorption as maintenance therapy for refractory neuromyelitis optica spectrum disorder |
| title_full_unstemmed | Immunoadsorption as maintenance therapy for refractory neuromyelitis optica spectrum disorder |
| title_short | Immunoadsorption as maintenance therapy for refractory neuromyelitis optica spectrum disorder |
| title_sort | immunoadsorption as maintenance therapy for refractory neuromyelitis optica spectrum disorder |
| url | https://doi.org/10.1177/17562864221150314 |
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