Abstract Details

Title The Association Between Neighborhood Disadvantage and Exposure to Plasma Exchange During Attacks in AQP4-IgG+ NMOSD

Topic Autoimmune Neurology

Presentation(s) P4 - Poster Session 4 (8:00 AM-9:00 AM)

Poster/Presentation
Number 1-007

Objective To assess whether neighborhood disadvantage is associated with exposure to plasma exchange (PLEX) during attacks in patients with aquaporin-4-immunoglobulin-G+ (AQP4-IgG+) neuromyelitis optica spectrum disorder (NMOSD).

Background Early treatment of AQP4-IgG+ NMOSD attacks with PLEX is associated with better outcomes. However, PLEX requires significant healthcare infrastructure; therefore, PLEX exposure could be impacted by neighborhood disadvantage.

Design/Methods All adult AQP4-IgG+ NMOSD patients at the Cleveland Clinic were included in this retrospective cohort study. Attacks were limited to those occurring after AQP4-IgG seropositivity. Multivariable logistic regression models evaluated the association between PLEX exposure during treatment of an attack and neighborhood disadvantage. Neighborhood disadvantage (yes or no) was determined using the Area Deprivation Index-3 (ADI-3) and defined as the most disadvantaged 15% of Americans regarding financial strength, educational attainment, economic hardship/inequality, or overall ADI. We adjusted for age, race, and insurance type (Medicaid or non-Medicaid).

Results We included 168 AQP4-IgG+ NMOSD individuals. The mean age at diagnosis was 47±18 years, 89% were female, and 41% were Black. Ninety-eight individuals had a relapse after AQP4-IgG seropositivity, of which 48 (49%) received PLEX. PLEX exposure was not significantly associated with neighborhood disadvantage including financial strength (odds ratio [OR] 0.90, confidence interval [CI] 0.24-3.20, p=0.87), educational attainment (OR 1.81, CI 0.36-9.36, p=0.46), economic hardship/inequality (OR 3.58, CI 0.93-13.78, p=0.06), or overall ADI (OR 1.42, CI 0.52-3.87, p=0.49). Older age at diagnosis (OR 1.03-1.04, CI 1.01-1.07, p<0.05) and Medicaid insurance (OR 5.01-6.13, CI 1.04-30.21, p<0.05) were associated with increased odds of PLEX exposure in all multivariable models.

Conclusions Neighborhood disadvantage was not associated with exposure to PLEX, suggesting that disadvantage was not a barrier. Those on Medicaid had greater odds of PLEX exposure, warranting further investigation into payor effect on PLEX exposure and underlying confounders.

Authors/Disclosures
Kaitlyn Palmer, MD PRESENTER	Dr. Palmer has nothing to disclose.
Devon Conway, MD	Dr. Conway has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Bristol Myers Squibb. Dr. Conway has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Alexion. Dr. Conway has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Genentech. Dr. Conway has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Amgen. Dr. Conway has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Biogen. Dr. Conway has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Biogen. The institution of Dr. Conway has received research support from Novartis. The institution of Dr. Conway has received research support from BMS. The institution of Dr. Conway has received research support from Biogen.
Mengke Du (Cleveland Clinic)	Mengke Du has nothing to disclose.
Albert Aboseif, DO (Mayo Clinic Rochester)	Dr. Aboseif has received research support from the Eugene & Marcia Applebaum Fellowship Grant.
Carol Swetlik, MD (Cleveland Clinic)	An immediate family member of Dr. Swetlik has received personal compensation for serving as an employee of Pfizer. Dr. Swetlik has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genetech. Dr. Swetlik has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Amgen.
Julie Widmar, NP	Ms. Widmar has received personal compensation for serving as an employee of Amgen .
Amy Kunchok, MBBS (Cleveland Clinic - Mellen Centre)	Dr. Kunchok 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 Neurology:Open Access Journal .
Deborah M. Miller, PhD (Cleveland Clinic Foundation)	Dr. Miller has received intellectual property interests from a discovery or technology relating to health care.
Julia O'Mahony (The Hospital for Sick Children)	Ms. O'Mahony has nothing to disclose.
Justin Abbatemarco, MD	Dr. Abbatemarco has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for EMD Serono. Dr. Abbatemarco 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. Abbatemarco 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. Abbatemarco has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for TG Therapeutics, Inc.. Dr. Abbatemarco 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. The institution of Dr. Abbatemarco has received research support from Amgen.

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