PLEX: the best first-line treatment in nmosd attacks experience at a single center in Colombia

Abstract

Objective: Primary outcome was to evaluate complete improvement at six months after acute treatment in NMOSD relapses.

Methods: Retrospective observational cohort study of patients with diagnosis of NMOSD admitted for acute attacks. We performed an explanatory analysis using the univariate, bivariate and multivariate logistic regression approach. We compared survival curves using the Kaplan Meier analysis and estimated the median time for the main outcome.

Results: In the univariate analysis, basal EDSS score, AQP4-IgG positivity, PLEX as a first-line treatment (IVMP + PLEX), less systemic complications related to acute treatment and total attack history were independently associated with complete improvement at six months. After adjusting for confounding variables and using multivariate analysis by Cox Regression, positive AQ4-IgG (HR 0.04, 95% CI: 0.02-0.66) and IVMP + PLEX (HR 5.1, 95% CI: 3.9-66.4), were kept as independent factors associated to time to complete improvement. Time from admission to PLEX initiation and complete improvement at six months had a median of seven days (95% CI: 5.2-8.8). In secondary effects, there were no statistical differences between the groups.

Conclusions: PLEX + IVMP is the treatment of choice for NMOSD relapses and should be initiated as early as possible.

Keywords: All demyelinating disease (CNS); Autoimmune diseases; Devic's syndrome; Optic neuritis; Transverse myelitis.

Figure 1

Survival function of time to PLEX initiation since admission in days Median time to PLEX initiation from admission: seven days. The probability of complete improvement started decreasing to less than 60% at day seven. PLEX: plasma exchange. Y: Accumulate survival; X: time to PLEX initiation since admission in days..