Abstract Details

Title Effectiveness and Outcome Predictors of Acute Plasma Exchange for Myelin Oligodendrocyte Glycoprotein Antibody Associated Disease

Topic Autoimmune Neurology

Presentation(s) S38 - NMOSD, MOGAD, Demyelinating, and Other (1:36 PM-1:48 PM)

Poster/Presentation
Number 004

Objective To evaluate the outcomes of PLEX for attacks in MOGAD

Background

Multiple studies have shown PLEX effectiveness in severe acute attacks in CNS inflammatory diseases including MS and NMOSD. However, studies on PLEX in MOGAD remain limited.

Design/Methods This international multicenter retrospective cohort study included 243 attacks from 234 MOGAD patients who underwent PLEX from 18 tertiary care centers in 6 countries. We assessed the frequency of complete recovery (CR), clinically significant improvement (CSI), final visual acuity (VA) and Expanded Disability Status Scale (EDSS) at least 3 months post-attack. Logistic regression analyses were performed to identify predictors of CR and CSI.

Results Of 234 patients, 135 (58%) were female. The median (interquartile range; IQR) age at attack was 34 (IQR 22-49) years. The most common attack phenotypes were 161 optic neuritis (ON), 77 myelitis, 24 acute disseminated encephalomyelitis, and 15 brainstem/cerebellar. In addition to PLEX, 239 (99%) attacks received corticosteroids and 32 (13%) intravenous immunoglobulin. VA in ON attacks improved from 20/400 (20/70-hand motion) before PLEX to 20/20 (20/20-20/30), and EDSS of all attacks significantly decreased from a median of 4.0 (3.0-6.5) to 1.0 (0.0-2.5). Of 229 attacks without subsequent attacks within 3 months, 100 (44%) achieved CR, and 213 (93%) CSI. The probability of CR was decreased with advanced age [adjusted odd ratio (95% confidence interval) 0.97 (0.96-0.99) per year], higher EDSS worsening from baseline [0.66 (0.54-0.81 per 0.5 increment] and delayed PLEX [0.98 (0.96-0.99) per day]. Advanced age [0.97 (0.96-0.99) per year] and delayed PLEX [0.95 (0.94-0.96) per day] decreased probability of CSI.

Conclusions PLEX is associated with favorable outcomes in MOGAD attacks, particularly in young patients and when initiated early.

Authors/Disclosures
Smathorn Thakolwiboon, MD (Mayo Clinic Health System) PRESENTER	Dr. Thakolwiboon has nothing to disclose.
Vyanka Redenbaugh, MB BCh BAO (Mayo Clinic)	Dr. Redenbaugh has nothing to disclose.
Bo Chen, MD, PhD (John Radcliffe Hospital, University of Oxford)	Dr. Chen has nothing to disclose.
Sage T. Hewitt, MD (VUMC)	Dr. Hewitt has nothing to disclose.
Shailee S. Shah, MD (Vanderbilt Multiple Sclerosis Center)	Dr. Shah has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Horizon Therapeutics. Dr. Shah has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genentech. Dr. Shah has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genentech. Dr. Shah 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. Shah has received publishing royalties from a publication relating to health care.
Itay Lotan, MD (Rabin Medical Center)	Dr. Lotan has nothing to disclose.
Michael Levy, MD, PhD, FAAN (Massachusetts General Hospital/Harvard Medical School)	Dr. Levy has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Mitsubishi Pharma. Dr. Levy has received personal compensation in the range of $500-$4,999 for serving as a Consultant for UCB Pharma. Dr. Levy has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Sanofi. Dr. Levy has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion. Dr. Levy has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Horizon. Dr. Levy has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genentech. Dr. Levy has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Elsevier. Dr. Levy has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Various law firms. The institution of Dr. Levy has received research support from National Institutes Health.
Mirasol Forcadela, MD	Dr. Forcadela has nothing to disclose.
Saif Huda, MD (NHS)	Dr. Huda has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Guidepoint.
Julie Pique, MD	Dr. Pique has nothing to disclose.
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.
Clemence Boutiere, MD	Dr. Boutiere has nothing to disclose.
Bertrand Audoin	No disclosure on file
Pascale Poullin, MD	Dr. Poullin has nothing to disclose.
Dimitrios Champsas, MD	Dr. Champsas has nothing to disclose.
David Choi	Mr. Choi has nothing to disclose.
Helen Danesh-Meyer, MD, PhD	Prof. Danesh-Meyer has nothing to disclose.
Eleni Vasileiou, MD (Mount Sinai)	Dr. Vasileiou has nothing to disclose.
Elias S. Sotirchos, MD (Johns Hopkins University)	Dr. Sotirchos has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genentech. Dr. Sotirchos has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion. Dr. Sotirchos has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Amgen. Dr. Sotirchos has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for TG Therapeutics. The institution of Dr. Sotirchos has received research support from National Institutes of Health. The institution of Dr. Sotirchos has received research support from National Multiple Sclerosis Society. The institution of Dr. Sotirchos has received research support from Sumaira Foundation. The institution of Dr. Sotirchos has received research support from Genentech. The institution of Dr. Sotirchos has received research support from UCB. The institution of Dr. Sotirchos has received research support from Astoria Biologica. The institution of Dr. Sotirchos has received research support from Ad Scientiam. The institution of Dr. Sotirchos has received research support from Alexion. The institution of Dr. Sotirchos has received research support from Corevitas. Dr. Sotirchos has received personal compensation in the range of $500-$4,999 for serving as a Ad Hoc Reviewer with National Institutes of Health.
James B. Davis, MD	Dr. Davis has nothing to disclose.
Amanda D. Henderson, MD	Dr. Henderson has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Amgen. Dr. Henderson has received publishing royalties from a publication relating to health care.
Adi Wilf-Yarkoni, MD	Dr. Wilf-Yarkoni has nothing to disclose.
Hadas Stiebel-Kalish, MD	Prof. Stiebel-Kalish has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Roche Pharmaceuticals. Prof. Stiebel-Kalish has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Israeli Judicial System.
Elisabeth Maillart, MD	Dr. Maillart has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Alexion. Dr. Maillart has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novartis. Dr. Maillart has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Biogen. Dr. Maillart has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Janssen. Dr. Maillart has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Amgen. Dr. Maillart has received personal compensation in the range of $0-$499 for serving as a Consultant for Sanofi. Dr. Maillart has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Sandoz. The institution of Dr. Maillart has received research support from Biogen.
Laura Bonelli (UCLA)	An immediate family member of Laura Bonelli has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Apellis.
Anthony Arnold, MD	Prof. Arnold has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Apellis.
Marine Boudot de la Motte, MD	Dr. Boudot de la Motte has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novartis. Dr. Boudot de la Motte has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion, Merck.
Romain Deschamps, Sr., MD	Dr. Deschamps has nothing to disclose.
Jiraporn Jitprapaikulsan, MD (Faculty of Medicine Siriraj Hospital)	Dr. Jitprapaikulsan has nothing to disclose.
Heather Moss, MD, PhD, FAAN (Spencer Center for Vision Research at Stanford)	Dr. Moss has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Twenty Twenty Therapeutics. Dr. Moss has received personal compensation in the range of $100,000-$499,999 for serving as a Consultant for Verana Health. Dr. Moss has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Medlink Inc. Dr. Moss has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Legal Firms. The institution of Dr. Moss has received research support from NIH. The institution of Dr. Moss has received research support from Department of Defense. The institution of Dr. Moss has received research support from Research to Prevent Blindness. Dr. Moss has received intellectual property interests from a discovery or technology relating to health care. Dr. Moss has received personal compensation in the range of $0-$499 for serving as a grant review panel with NASA. Dr. Moss has received personal compensation in the range of $0-$499 for serving as a grant review panel with National Institutes of Health. Dr. Moss has a non-compensated relationship as a Board of Directors with North American Neuro-ophthalmology Society that is relevant to AAN interests or activities.
Sylvia E. Villarreal Navarro, MD	Dr. Villarreal Navarro has nothing to disclose.
Yang Mao-Draayer, MD (University of Michigan, Department of Neurology)	Dr. Mao-Draayer has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Biogen Idec. Dr. Mao-Draayer has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Genzyme-Sanofi. Dr. Mao-Draayer has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Horizone . Dr. Mao-Draayer has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genzyme-Sanofi. Dr. Mao-Draayer 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. Mao-Draayer has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Horizone. Dr. Mao-Draayer has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Biogen Idec. The institution of Dr. Mao-Draayer has received research support from NIH .
Murli Mishra, MD, PhD (Vanderbilt University Medical Center)	Dr. Mishra has nothing to disclose.
Nisa Vorasoot, MD	Dr. Vorasoot has nothing to disclose.
Laura Cacciaguerra, MD, PhD (Mayo Clinic)	Dr. Cacciaguerra has nothing to disclose.
Nanthaya Tisavipat, MD (Mayo Clinic)	Miss Tisavipat has nothing to disclose.
Deena Tajfirouz, MD	Dr. Tajfirouz has nothing to disclose.
Jan-Mendelt Tillema, MD (Mayo Clinic)	Dr. Tillema has nothing to disclose.
Alfonso S. Lopez, MD (Mayo Clinic)	Dr. Lopez 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. Lopez has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genentech .
Jacqueline Palace (John Radcliff Hospital Oxford Univeristy Hospitals Trust)	Dr. Palace has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Merck Serono, Medimmune, Argenx, Janssen, AMgen, UCB, Roche, Novartis, Amplo, Alexion, . Dr. Palace has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Argenx, Sanofi. Dr. Palace has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Roche, UCB, Alexion, Amgen. Dr. Palace has stock in Astra Zenica. The institution of Dr. Palace has received research support from Roche, AMPLO, Alexion, UCB,. argenx, amgen. Dr. Palace has received intellectual property interests from a discovery or technology relating to health care.
Yael Hacohen, MBBS (Great Ormond Street Hospital)	Dr. Hacohen has nothing to disclose.
Sean J. Pittock, MD, FAAN (Mayo Clinic Dept of Neurology)	Dr. Pittock has received personal compensation in the range of $500-$4,999 for serving as a Consultant for UCB. Dr. Pittock has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Arialys Therapeutics. The institution of Dr. Pittock has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion. Dr. Pittock has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Arialys. The institution of Dr. Pittock has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for UCB. The institution of Dr. Pittock has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche/Genentech. The institution of Dr. Pittock has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Alexion/AstraZeneka. The institution of Dr. Pittock has received research support from NIH. The institution of Dr. Pittock has received research support from Alexion/AstraZeneka. The institution of Dr. Pittock has received research support from F. Hoffman/LaRoche/Genentech. Dr. Pittock has received intellectual property interests from a discovery or technology relating to health care. Dr. Pittock has received intellectual property interests from a discovery or technology relating to health care. Dr. Pittock has received publishing royalties from a publication relating to health care.
Eoin P. Flanagan, MBBCh, FAAN (Mayo Clinic)	The institution of Dr. Flanagan 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. Flanagan has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genentech. Dr. Flanagan has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Horizon Therapeutics. The institution of Dr. Flanagan 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. Dr. Flanagan has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Pharmacy times. The institution of Dr. Flanagan has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for UCB. The institution of Dr. Flanagan has received research support from Viela Bio. The institution of Dr. Flanagan has received research support from UCB. The institution of Dr. Flanagan has received research support from Roche. Dr. Flanagan has received publishing royalties from a publication relating to health care. Dr. Flanagan has a non-compensated relationship as a Member of medical Advisory Board with The MOG Project that is relevant to AAN interests or activities. Dr. Flanagan has a non-compensated relationship as a Editorial board member with Journal of The Neurologic Sciences that is relevant to AAN interests or activities. Dr. Flanagan has a non-compensated relationship as a Editorial board member with Neuroimmunology Reports that is relevant to AAN interests or activities. Dr. Flanagan has a non-compensated relationship as a Editorial Board Member with Neurology, Neuroimmunology Neuroinflammation (N2) Journal that is relevant to AAN interests or activities.
John Chen	John Chen has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for UCB. John Chen has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Amgen.

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