TY - JOUR
T1 - Quotient of cerebrospinal fluid/serum immunoglobulin G as a predictive factor for non-responders to intravenous methylprednisolone therapy in patients with relapsing neuromyelitis optica spectrum disorder
T2 - Implication for early initiation of plasmapheresis
AU - Oji, Satoru
AU - Tanaka, Satoru
AU - Kojima, Miki
AU - Fukaura, Hikoaki
AU - Mori, Masahiro
AU - Takahashi, Toshiyuki
AU - Fujihara, Kazuo
AU - Nomura, Kyoichi
N1 - Publisher Copyright:
© 2016 Japanese Society for Neuroimmunology
PY - 2016/8/1
Y1 - 2016/8/1
N2 - Objectives: We aimed to determine the predictive factors for the ineffectiveness of intravenous methylprednisolone (IVMP) that lead to earlier use of plasmapheresis in patients with relapsing neuromyelitis optica spectrum disorder. Methods: A total of 40 patients were investigated retrospectively. The responders were defined as patients who showed IVMP effectiveness within 7 days from IVMP initiation, indicated by an improvement in the Kurtzke Expanded Disability Status Scale (EDSS) ≥0.5, whereas non-responders were defined as those without such an improvement. We analyzed 10 clinical findings and four cerebrospinal fluid (CSF) parameters before IVMP, which included EDSS (baseline before relapse, before IVMP initiation, difference between them: ΔEDSS), CSF-cells, CSF-lactate dehydrogenase, CSF/serum quotient of albumin (Q-ALB) and immunoglobulin G (Q-IgG). Results: The 40 patients consisted of 22 responders and 18 non-responders. The levels of ΔEDSS, EDSS before IVMP, CSF-cells, CSF-lactate dehydrogenase, Q-ALB and Q-IgG were significantly higher in non-responders than in responders. Of these, univariate logistic regression analyses showed that the ΔEDSS, EDSS before IVMP, Q-ALB and Q-IgG were significantly related to IVMP ineffectiveness. Because of the significant correlation between ΔEDSS and EDSS before IVMP, and between Q-ALB and Q-IgG, the ΔEDSS and Q-IgG were analyzed as dependent factors for IVMP ineffectiveness in multivariate analysis. The higher Q-IgG level was found to be independently associated with ineffectiveness. The cut-off level for Q-IgG to discriminate non-responders from responders was 4.7 (sensitivity 83, specificity 91%). Conclusions: Q-IgG >4.7 before IVMP is a predictive factor for IVMP ineffectiveness. Early use of plasmapheresis should be considered in relapsing neuromyelitis optica spectrum disorder with such high Q-IgG values before IVMP.
AB - Objectives: We aimed to determine the predictive factors for the ineffectiveness of intravenous methylprednisolone (IVMP) that lead to earlier use of plasmapheresis in patients with relapsing neuromyelitis optica spectrum disorder. Methods: A total of 40 patients were investigated retrospectively. The responders were defined as patients who showed IVMP effectiveness within 7 days from IVMP initiation, indicated by an improvement in the Kurtzke Expanded Disability Status Scale (EDSS) ≥0.5, whereas non-responders were defined as those without such an improvement. We analyzed 10 clinical findings and four cerebrospinal fluid (CSF) parameters before IVMP, which included EDSS (baseline before relapse, before IVMP initiation, difference between them: ΔEDSS), CSF-cells, CSF-lactate dehydrogenase, CSF/serum quotient of albumin (Q-ALB) and immunoglobulin G (Q-IgG). Results: The 40 patients consisted of 22 responders and 18 non-responders. The levels of ΔEDSS, EDSS before IVMP, CSF-cells, CSF-lactate dehydrogenase, Q-ALB and Q-IgG were significantly higher in non-responders than in responders. Of these, univariate logistic regression analyses showed that the ΔEDSS, EDSS before IVMP, Q-ALB and Q-IgG were significantly related to IVMP ineffectiveness. Because of the significant correlation between ΔEDSS and EDSS before IVMP, and between Q-ALB and Q-IgG, the ΔEDSS and Q-IgG were analyzed as dependent factors for IVMP ineffectiveness in multivariate analysis. The higher Q-IgG level was found to be independently associated with ineffectiveness. The cut-off level for Q-IgG to discriminate non-responders from responders was 4.7 (sensitivity 83, specificity 91%). Conclusions: Q-IgG >4.7 before IVMP is a predictive factor for IVMP ineffectiveness. Early use of plasmapheresis should be considered in relapsing neuromyelitis optica spectrum disorder with such high Q-IgG values before IVMP.
KW - intravenous methylprednisolone therapy
KW - neuromyelitis optica spectrum disorder
KW - non-responders
KW - plasmapheresis
KW - quotient of cerebrospinal fluid/serum immunoglobulin G
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U2 - 10.1111/cen3.12318
DO - 10.1111/cen3.12318
M3 - Article
AN - SCOPUS:84979779442
VL - 7
SP - 272
EP - 280
JO - Clinical and Experimental Neuroimmunology
JF - Clinical and Experimental Neuroimmunology
SN - 1759-1961
IS - 3
ER -