Earlier Treatment of Acute Relapses in Neuromyelitis Optica Spectrum Disorder Leads to Better Outcomes (P6.385)

Objective: To determine the outcome of immunosuppressive treatment of acute neuromyelitis optica spectrum disorder (NMOSD) relapses stratified by start time of treatment relative to relapse onset. Background: Neuromyelitis optica Spectrum Disorder (NMOSD) is a rare, autoimmune disease that preferentially causes optic neuritis and transverse myelitis leading to blindness and paralysis. The standard of care for treatment of acute NMOSD relapses is immunosuppression with high dose corticosteroids and/or plasma exchange. The optimal timing for initiation of treatment is thought to be “sooner than later” but data are lacking regarding the outcomes based on treatment start times. Design/Methods: This is a retrospective study of 51 NMOSD relapses treated at the Johns Hopkins Hospital between 2009 and 2016. Subjects were divided into three groups based on start time of treatment: within 72 hours of relapse onset, 3–7 days and u003e 7 days. Expanded disability status scores (EDSS) were calculated for baseline, presentation, discharge and follow up after 6–12 months. Relapses were defined as new symptoms associated with new examination finding and a new or enhancing MRI lesion. Results: Twenty-one subjects were treated within 72 hours, 15 were treated between 3–7 days and 15 were treated u003e 7 days after relapse onset. There was no difference in anti-AQP4 seropositivity, age at relapse, duration of disease, sex, race or location of lesion (optic nerve/spinal cord). Treatment included high dose corticosteroids for 5 days in all patients, with plasma exchange required in 43%, 40% and 60% of subjects in each group, respectively. There was no difference in the baseline EDSS prior to admission, nor in the degree of severity of the relapse. However, there were significantly poorer outcomes in the groups with delay in treatment beyond 72 hours. On average, EDSS scores improved by 1.5 points in the 7 days groups. Similarly, patients in the Conclusions: Early treatment within 72 hours of onset to suppress inflammation in acute NMOSD relapses leads to improved neurological outcomes. Disclosure: Dr. Coleman has nothing to disclose. Dr. Ng has nothing to disclose. Dr. Mealy has received personal compensation for activities with Consortium of Multiple Sclerosis Centers as a speaker. Dr. Levy has received personal compensation from Alexion, Guidepoint Global, Genzyme and Acorda.