Monday, June 2, 2014

Treatment of Devic's: comparison study

Mealy MA, Wingerchuk DM, Palace J.  Comparison of relapse and treatment failure rates among patietns with neuromyelitis optica: multicenter study of treatment efficacy.  Jama Neurology 2014; 71:324-330.
Retrospective analysis od 90 patients seen over 10 years at Mayo Clinic and JHH treated with azathioprine (n=32), mycophenolate (n=28), and /or rituximab (n=30).
Azathioprine reduced the relapse rate 72 % with 53 % failure rate despite concurrent use of prednisone
Mycophenolate reduced relapse rate 87 % with a 36 % failure rate.
Rituximab had an 88 % reduction in relapse rate, with 33 % failure rate.
With optimal dosing, rituximab had only a 17 % failure rate.  Ideal dosing was 1000 mg iv, with premedication dose of 100 mg methylprednisolone, with dosage repeated 2 weeks later.  CD 19 was tested monthly, and repeat paired rituximab dosing occurred upon detection of greater than 0.1 % CD19 in total lymphocytes or at regular 6 month intervals.   

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