Abstract Details

Title Real-world data on eculizumab treatment in NMOSD: high efficacy and potential challenges

Topic Autoimmune Neurology

Presentation(s) P13 - Poster Session 13 (8:00 AM-9:00 AM)

Poster/Presentation
Number 6-017

Objective

To evaluate efficacy and safety of eculizumab (ECU) in a large real-world Neuromyelitis optica spectrum disorder (NMOSD) cohort.

Background

Real-world data on Eculizumab in NMOSD are still scarce. The drug was highly effective in preventing relapses in the phase-III PREVENT trial and is approved for AQP4-IgG+ NMOSD, but carries potential risk of life-threatening meningococcal infection. Therefore, appropriate vaccination or antibiotic prophylaxis are mandatory.

Design/Methods

In this retrospective multicenter study we analyzed annualized relapse rate (ARR), disability (EDSS) and rate of serious infections during ECU, as well as tolerability of meningococcal vaccination.

Results

55 patients (52 AQP4-IgG+, 84% female, 48.6±16.6 years) with an active NMOSD (median ARR 1.0, EDSS 6.0) were included. 13/55 were treatment-naive and 42/55 switched from another immunotherapy. 38/55 experienced a relapse or asymptomatic MRI activity <3 months before ECU. During ECU-treatment (17.4±15.4 months) ARR dropped significantly (from 1.0(0-3.0) to 0(0-1.4), p<0.001), 86% of patients were relapse-free. The median EDSS remained stable.

39/55 patients received at least one meningococcal vaccination prior-to-ECU, resulting in a significant treatment delay comparing to those with antibiotic prophylaxis. 9/39 patients have been vaccinated despite concomitant oral prednisone and reported no relapses. In contrast 10/30 (33%) patients vaccinated prior-to-ECU without prednisone experienced new attacks shortly thereafter (interval 9.5±7.7 days). None of 24/55 vaccinated during ECU relapsed during following 4 weeks.

Despite vaccination one patient developed meningococcal sepsis, 4 other multimorbid patients experienced non-meningococcal systemic infections. Five patients died during ECU, three in the context of sepsis and two due to myocardial infarction and ileus, respectively. Ten further patients discontinuated ECU due to different reasons.

Conclusions

Real-world data confirm high efficacy of eculizumab in NMOSD. Risk of relapses in patients vaccinated prior to eculizumab start and potential severe infections in multimorbid patients must be considered. Further studies are needed to establish an optimal vaccination schedule in active NMOSD.

Authors/Disclosures
Ilya Ayzenberg (Ruhr-Universitat Bochum) PRESENTER	Dr. Ayzenberg has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche. Dr. Ayzenberg has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Merck. Dr. Ayzenberg has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Sanofi Aventis. Dr. Ayzenberg has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion. Dr. Ayzenberg has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Horizon. Dr. Ayzenberg has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Alexion. Dr. Ayzenberg has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Roche. Dr. Ayzenberg has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Merck. The institution of Dr. Ayzenberg has received research support from Diamed.
	No disclosure on file
	No disclosure on file
	No disclosure on file
Refik Pul	Refik Pul has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Alexion, BMS, Hexal, Horizon, Janssen, Merck, Novartis, Sanofi . Refik Pul has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion, BMS, Hexal, Horizon, Janssen, Merck, Novartis, Sanofi .
	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file
Kerstin Hellwig (St. Josef Hospital Bochum)	Kerstin Hellwig has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Teva . Kerstin Hellwig has received personal compensation in the range of $500-$4,999 for serving as a Consultant for BMS. Kerstin Hellwig has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Novartis . Kerstin Hellwig has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Roche . Kerstin Hellwig has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Merck . Kerstin Hellwig has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Sanofi Genzyme . Kerstin Hellwig has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Mylan . Kerstin Hellwig has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis . Kerstin Hellwig has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche . Kerstin Hellwig has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Merck . Kerstin Hellwig has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Novartis . Kerstin Hellwig has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Roche . The institution of Kerstin Hellwig has received research support from Roche . The institution of Kerstin Hellwig has received research support from Merck . The institution of Kerstin Hellwig has received research support from Biogen. The institution of Kerstin Hellwig has received research support from Genzyme . The institution of Kerstin Hellwig has received research support from Novartis . The institution of Kerstin Hellwig has received research support from BMS .
Friedemann Paul (Charite Universitatsmedizin in Berlin)	Dr. Paul has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Hexal. Dr. Paul has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Alexion. Dr. Paul has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Merck. Dr. Paul has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Hexal. Dr. Paul has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Hoffmann-La Roche. Dr. Paul has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Merck. Dr. Paul has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Roche. Dr. Paul has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Bristol-Myers Squibb GmbH & Co. KGaA (BMS. Dr. Paul has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Hexal. Dr. Paul has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Merck. Dr. Paul has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novartis. Dr. Paul has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Roche. Dr. Paul has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Teva. Dr. Paul has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Horizon Therapeutics GmbH. Dr. Paul has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Hexal. Dr. Paul has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Roche. Dr. Paul has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for UCB. Dr. Paul has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Roche. Dr. Paul has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Roche. Dr. Paul has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for UCB. Dr. Paul has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche. Dr. Paul has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion. Dr. Paul has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for sanofi. Dr. Paul has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche . Dr. Paul has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for F&U Confirm. Dr. Paul has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Novartis. Dr. Paul has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Alexion. Dr. Paul has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Bristol Myers Squibb GesmbH. Dr. Paul has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for MICE Service. Dr. Paul has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Alexion. Dr. Paul has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Novartis. Dr. Paul has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Novartis. Dr. Paul has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Roche. Dr. Paul has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Alexion. Dr. Paul has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Roche. Dr. Paul has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Biogen. Dr. Paul has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Amgen. Dr. Paul has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Sanofi. Dr. Paul has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Roche. Dr. Paul has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for VINDICO medical education. Dr. Paul has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Amgen. Dr. Paul has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for UCB. Dr. Paul has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Sanofi. Dr. Paul has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Beijing Novartis. Dr. Paul has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Roche. Dr. Paul has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Sandoz Internation GmbH. Dr. Paul has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Amgen. Dr. Paul has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Roche. Dr. Paul has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Alexion. Dr. Paul has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Novartis. Dr. Paul has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Roche Thailand. Dr. Paul has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Roche . Dr. Paul has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Alexion. Dr. Paul has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Neurology, Neuroimmunology&Neuroinflammation.
Judith Bellmann-Strobl, MD (Bharite University of Medicine Berlin)	Judith Bellmann-Strobl, MD has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Roche. Judith Bellmann-Strobl, MD has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Merck. Judith Bellmann-Strobl, MD has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Sanofi Genzyme. Judith Bellmann-Strobl, MD has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche. The institution of Judith Bellmann-Strobl, MD has received research support from Bayer. The institution of Judith Bellmann-Strobl, MD has received research support from NEMOS.
	No disclosure on file
Klemens Ruprecht, MD (Klinik fur Neurologie)	Dr. Ruprecht has received research support from European Union (821283-2). Dr. Ruprecht has received research support from Merck Serono. Dr. Ruprecht has received research support from Stiftung Charite. Dr. Ruprecht has received research support from Arthur Arnstein Foundation. Dr. Ruprecht has received publishing royalties from a publication relating to health care.
Tjalf Ziemssen, MD, FAAN (University Clinic Dresden)	Dr. Ziemssen has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Roche. Dr. Ziemssen has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novartis. Dr. Ziemssen has received personal compensation in the range of $500-$4,999 for serving as a Consultant for BMS . Dr. Ziemssen has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Merck. Dr. Ziemssen has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Roche. Dr. Ziemssen has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Novartis. Dr. Ziemssen has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Merck. Dr. Ziemssen has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Sanofi. Dr. Ziemssen has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for TEVA. Dr. Ziemssen has received personal compensation in the range of $500-$4,999 for serving as an officer or member of the Board of Directors for Dresden Internation University. The institution of Dr. Ziemssen has received research support from Novartis. The institution of Dr. Ziemssen has received research support from Merck. The institution of Dr. Ziemssen has received research support from Sanofi. The institution of Dr. Ziemssen has received research support from BMS. The institution of Dr. Ziemssen has received research support from Roche.
	No disclosure on file
Veit Rothhammer, MD (Universität Erlangen-Nuernberg)	Prof. Rothhammer has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis. Prof. Rothhammer has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Merck. The institution of Prof. Rothhammer has received research support from German Research Foundation. The institution of Prof. Rothhammer has received research support from European Research Council.
Florian Nickel	Florian Nickel has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biogen. Florian Nickel has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Janssen. Florian Nickel has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Merck Serono. Florian Nickel has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion. Florian Nickel has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Biogen. Florian Nickel has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for BMS.
Klemens Angstwurm, MD (Department of Neurology, University of Regensburg)	Dr. Angstwurm has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Biogen. Dr. Angstwurm has received personal compensation in the range of $500-$4,999 for serving as a Consultant for TEVA.
Ralf Linker (Uniklinik Erlangen)	Dr. Linker has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis. Dr. Linker has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Springer. The institution of Dr. Linker has received research support from Novartis. The institution of Dr. Linker has received research support from Biogen.
Clemens Warnke (Klinik Fuer Neurologie, University of Duesseldorf)	The institution of Clemens Warnke has received research support from Novartis. The institution of Clemens Warnke has received research support from Alexion. The institution of Clemens Warnke has received research support from Sanofi-Genzyme. The institution of Clemens Warnke has received research support from Biogen. The institution of Clemens Warnke has received research support from Roche.
Sven O. Jarius, MD (University of Heidelberg)	Dr. Jarius has nothing to disclose.
Mirjam Korporal-Kuhnke, MD	Dr. Korporal-Kuhnke has nothing to disclose.
Brigitte Wildemann, MD (University Hospital Heidelberg, Department of Neurology)	The institution of Dr. Wildemann has received research support from Roche. The institution of Dr. Wildemann has received research support from Novartis. The institution of Dr. Wildemann has received research support from Argenx. Dr. Wildemann has received personal compensation in the range of $500-$4,999 for serving as a Conference participant with Neuraxpharm. Dr. Wildemann has received personal compensation in the range of $0-$499 for serving as a Speaker with Roche. Dr. Wildemann has received personal compensation in the range of $0-$499 for serving as a Soeaker with Instand.
	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file
Uwe Zettl	Uwe Zettl has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Merck Serono. Uwe Zettl has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Alexion . Uwe Zettl has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Bayer. Uwe Zettl has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Roche. Uwe Zettl has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Teva. The institution of Uwe Zettl has received research support from BMBF(Government).
Paulus S. Rommer (AKH Wien / Univ. Klinik Fuer Neurologie)	Dr. Rommer has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Alexion. Dr. Rommer has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Roche. Dr. Rommer has received personal compensation in the range of $500-$4,999 for serving as a Consultant for biogen. The institution of Dr. Rommer has received personal compensation in the range of $500-$4,999 for serving as a Consultant for celgene. The institution of Dr. Rommer has received personal compensation in the range of $500-$4,999 for serving as a Consultant for merck. Dr. Rommer has received personal compensation in the range of $0-$499 for serving as a Consultant for sanofi. Dr. Rommer has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for sandoz. Dr. Rommer has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Abbvie. Dr. Rommer has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for almirall. Dr. Rommer has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for biogen. Dr. Rommer has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Novartis. Dr. Rommer has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Merck. The institution of Dr. Rommer has received research support from merck. The institution of Dr. Rommer has received research support from roche. The institution of Dr. Rommer has received research support from amicus. The institution of Dr. Rommer has received research support from biogen.
Markus Kowarik	Markus Kowarik has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Merck, Roche, Celgene, Sanofi-Genzyme, Novartis and Biogen. The institution of Markus Kowarik has received research support from Merck. The institution of Markus Kowarik has received research support from Sanofi Genzyme.
	No disclosure on file
Christian Geis	Christian Geis has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Alexion, Roche. Christian Geis has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion, Roche, Sobi.
	No disclosure on file
	No disclosure on file
	No disclosure on file
Luisa H. Klotz, MD (Uniklinik Münster)	Dr. Klotz has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Bayer. Dr. Klotz has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Biogen. Dr. Klotz has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Genzyme. Dr. Klotz has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Bristol Myers Squibb. Dr. Klotz has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Merck Serono. Dr. Klotz has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Novartis. Dr. Klotz has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Teva. Dr. Klotz has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Roche. Dr. Klotz has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche. Dr. Klotz has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis. Dr. Klotz has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion. Dr. Klotz has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Merck. Dr. Klotz has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Sanofi. Dr. Klotz has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Horizon. Dr. Klotz has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Viatris. Dr. Klotz has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for BMS. The institution of Dr. Klotz has received research support from Immunic AG. The institution of Dr. Klotz has received research support from Merck.
Ralf Gold, MD (Neurologische Universitaetsklinik)	Dr. Gold has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Biogen . Dr. Gold has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Novartis. Dr. Gold has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Roche. Dr. Gold has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Genzyme. Dr. Gold has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Bayer Vital. Dr. Gold has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Eisai Pharamaceuticals. Dr. Gold has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biogen. Dr. Gold has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche. Dr. Gold has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for SAGE Publishers. Dr. Gold has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Novartis. Dr. Gold has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Biogen. The institution of Dr. Gold has received research support from Novartis. The institution of Dr. Gold has received research support from Biogen.
Christoph Kleinschnitz, MD (University Hospitals Essen, Dep. of Neurology)	Dr. Kleinschnitz has nothing to disclose.
Sven G. Meuth (Uniklinik Düsseldorf, Klinik für Neurologie)	Sven G. Meuth has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Merck. Sven G. Meuth has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Novartis. Sven G. Meuth has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Almirall. Sven G. Meuth has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Celgene. Sven G. Meuth has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Genzyme. Sven G. Meuth has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Biogen. Sven G. Meuth has received personal compensation in the range of $500-$4,999 for serving as a Consultant for TEVA. Sven G. Meuth has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Roche.
Orhan Aktas, MD (Neurologische Klinik)	Dr. Aktas has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Alexion. Dr. Aktas has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Amgen/Horizon. Dr. Aktas has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Roche. Dr. Aktas has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Mitsubish Tanake. Dr. Aktas has received personal compensation in the range of $500-$4,999 for serving as a Consultant for UCB. Dr. Aktas has received personal compensation in the range of $500-$4,999 for serving as a Consultant for AstraZeneca. Dr. Aktas has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Sanofi. Dr. Aktas has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Alexion. Dr. Aktas has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Roche. Dr. Aktas has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Amgen/Horizon. The institution of Dr. Aktas has received research support from German Research Foundation. The institution of Dr. Aktas has received research support from German Ministry of Science. The institution of Dr. Aktas has received research support from Neuromyelitis optica Study Group (NEMOS).
Achim Berthele (School of Medicine, Technical University Munich, Klinikum rechts der Isar, Dept.)	Achim Berthele has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion. Achim Berthele has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche. Achim Berthele has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Merck. Achim Berthele has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Neuraxpharm. Achim Berthele has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Argenx. Achim Berthele has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for CSL Behring. Achim Berthele has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Sabofi. Achim Berthele has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Alexion. Achim Berthele has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Roche. Achim Berthele has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Argenx. Achim Berthele has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Novartis. Achim Berthele has received publishing royalties from a publication relating to health care.
Marius Ringelstein	Marius Ringelstein has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche. Marius Ringelstein has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion.

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