Abstract Details

Title Predictors of outcome after a first attack of NMOSD

Topic Autoimmune Neurology

Presentation(s) S21 - Autoimmune Neurology: Novel Diagnostic and Predictive Biomarkers and Immunopathologic Mechanisms of Disease (4:47 PM-4:58 PM)

Poster/Presentation
Number 008

Objective To define prognosis factors based on the clinical outcome 6 months after a first attack of NMOSD.

Background Few studies have assessed the predictive factors of recovery after attacks of NMOSD.

Design/Methods We restrospectively 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 NMO or NMOSD criteria with assessed status for AQP4 or MOG-Antibodies. The primary judgement criteria was the EDSS score at 6 months follow-up. We classified the subjects into 3 groups of outcome: non recovery (NR), complete recovery (CR) and partial recovery (PR).

Results We included 214 attacks for 187 subjects. MethylPrednisolone represented 73% of all treatment lines, followed by Plasmatic Exchanges, or PE, (24%) with a median onset at 9 days after symptoms onset. CR was reached in 19% (n=41), PR in 57% (n=122) and NR in 24% (n=51). Univariate analysis found that the positivity of MOG-Ab (p=0,008), versus AQP4-Ab positivity, was associated with better recovery chances (p=0,0001), whereas treatment escalation (p<0,05) and the PE delay increasing (p=0,001) was of worst prognosis. A second definition was used as follows: good responders if EDSS decreased of ≥ 2 points for an initial score ≥ 3 / 1 point if < 3, and poor responders if the EDSS decreased below these thresholds. According to it, 63% were good responders and 13% poor responders. The same predictors were found excepted for treatment escalation.

Conclusions Actual treatment strategies lead to a strong functionnal improvement in a majority of patient. AQP4-Ab positivity confers a poor prognosis contrary to MOG-Ab which appears linked to a better outcome. Furthermore, we found that each day of delayed PE initiation is linked to an increasing of 0,028 points of the 6 months EDSS.

Authors/Disclosures
Maxime Guillaume PRESENTER	Maxime Guillaume has nothing to disclose.
Bertrand Bourre	Bertrand Bourre has nothing to disclose.
Bertrand Audoin	No disclosure on file
	No disclosure on file
Caroline Papeix (GH Pitie Salpetriere)	Caroline Papeix has received personal compensation in the range of $500-$4,999 for serving as a Consultant for BIOGEN . Caroline Papeix has received personal compensation in the range of $500-$4,999 for serving as a Consultant for ROCHE . Caroline Papeix has received personal compensation in the range of $500-$4,999 for serving as a Consultant for MERCK. Caroline Papeix has received personal compensation in the range of $0-$499 for serving as a Consultant for NOVARTIS .
Mickael Cohen (CHU Pasteur)	No disclosure on file
	No disclosure on file
Jonathan Ciron, MD (CHU Toulouse)	Jonathan Ciron, MD has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Biogen. Jonathan Ciron, MD has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis. Jonathan Ciron, MD has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Merck. Jonathan Ciron, MD has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for BMS - Celgene. Jonathan Ciron, MD has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion.
Laure Michel	No disclosure on file
Romain Marignier, MD, PhD (Lyon University Hospital)	Dr. Marignier has received personal compensation in the range of $0-$499 for serving as a Consultant for UCB. Dr. Marignier has received personal compensation in the range of $500-$4,999 for serving as a Consultant for ALEXION. Dr. Marignier has received personal compensation in the range of $500-$4,999 for serving as a Consultant for ROCHE. Dr. Marignier has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Amgen. Dr. Marignier has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for ROCHE.
Nicolas Collongues, MD (Hopital Civil)	Nicolas Collongues, MD has nothing to disclose.

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