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Moura J, Samões R, Sousa AP, Figueiroa S, Mendonça T, Abreu P, Guimarães J, Melo C, Sousa R, Soares M, Correia AS, Marques IB, Perdigão S, Alves I, Felgueiras H, Nzwalo H, Mendes I, Almeida V, Boleixa D, Carneiro P, Neves E, Silva AM, Sá MJ, Santos E. Prognostic factors associated with disability in a cohort of neuromyelitis optica spectrum disorder and MOG-associated disease from a nationwide Portuguese registry. J Neurol Sci 2024; 464:123176. [PMID: 39146881 DOI: 10.1016/j.jns.2024.123176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 08/08/2024] [Accepted: 08/11/2024] [Indexed: 08/17/2024]
Abstract
INTRODUCTION Neuromyelitis optica spectrum disorders (NMOSD) and MOG-associated disease (MOGAD) are an increasingly recognized group of demyelinating disorders of the central nervous system. Previous studies suggest that prognosis is predicted by older age at onset, number of relapses, the severity of the first attack and autoantibody status. OBJECTIVE To study prognostic factors associated with disability progression and additional relapses in the 3-year follow-up of a national NMOSD/MOGAD cohort. RESULTS Out of 180 of the initial Portuguese cohort, data on 82 patients was available at the end of the follow-up period (2019-2022). Two patients died. Twenty (24.4%) patients had one or more attack in this period (25 attacks in total), mostly transverse myelitis (TM) (56.0%) or optic neuritis (32.0%). MOGAD was significantly associated with a monophasic disease course (p = 0.03), with milder attacks (p = 0.01), while AQP4 + NMOSD was associated with relapses (p = 0.03). The most common treatment modalities were azathioprine (38.8%) and rituximab (18.8%). AQP4 + NMOSD more frequently required chronic immunosuppressive treatment, particularly rituximab (p = 0.01). Eighteen (22.5%) had an EDSS ≥6 at the end of the follow-up. AQP4 + NMOSD (p < 0.01) and the occurrence of transverse myelitis (TM) during disease (p = 0.04) correlated with an EDSS≥6 at the end of the follow-up period. MOGAD was significantly associated with an EDSS<6 (p < 0.01), and MOG+ cases that reached an EDSS>6 were significantly older (64.0 ± 2.8 versus 31.0 ± 17.1, p = 0.017). A bivariate logistic regression model including the serostatus and TM attacks during disease history successfully predicted 72.2% of patients that progressed to an EDSS≥6. CONCLUSION This study highlights that myelitis predict increased disability (EDSS≥6) in NMOSD/MOGAG and AQP4 positivity is associated with increased disability.
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Affiliation(s)
- João Moura
- Neurology Service, Department of Neurosciences, Centro Hospitalar Universitário de Santo António, Porto, Portugal.
| | - Raquel Samões
- Neurology Service, Department of Neurosciences, Centro Hospitalar Universitário de Santo António, Porto, Portugal; Unit for Multidisciplinary Research in Biomedicine, Instituto de Ciências Biomédicas de Abel Salazar da Universidade do Porto, Porto, Portugal
| | - Ana Paula Sousa
- Neurology Service, Department of Neurosciences, Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - Sónia Figueiroa
- Neuropediatrics Service, Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - Teresa Mendonça
- Neurology Service, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Pedro Abreu
- Neurology Service, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Joana Guimarães
- Neurology Service, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Claúdia Melo
- Neuropediatrics Service, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Raquel Sousa
- Neuropediatrics Service, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Mafalda Soares
- Neurology Service, Centro Hospitalar Lisboa Central, Lisboa, Portugal
| | - Ana Sofia Correia
- Neurology Service, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal
| | | | - Sandra Perdigão
- Neurology Service, Hospital de Viana do Castelo/Unidade Local de Saúde do Alto Minho, Viana do Castelo, Portugal
| | - Ivânia Alves
- Neurology Service, Centro Hospitalar Tâmega e Sousa, Penafiel, Portugal
| | - Helena Felgueiras
- Neurology Service, Centro Hospitalar de Vila Nova de Gaia e Espinho, Vila Nova de Gaia, Portugal
| | - Hipólito Nzwalo
- Neurology Unit, Hospital do Litoral Alentejano, Santiago do Cacém, Portugal
| | - Irene Mendes
- Neurology Service, Hospital Garcia da Orta, Almada, Portugal
| | - Vânia Almeida
- Neurology Service, Hospital de Vila Franca de Xira, Vila Franca de Xira, Portugal
| | - Daniela Boleixa
- Departamento de Ensino, Formação e Investigação (DEFI), Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - Paula Carneiro
- Unit for Multidisciplinary Research in Biomedicine, Instituto de Ciências Biomédicas de Abel Salazar da Universidade do Porto, Porto, Portugal; Immunology Service, Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - Esmeralda Neves
- Unit for Multidisciplinary Research in Biomedicine, Instituto de Ciências Biomédicas de Abel Salazar da Universidade do Porto, Porto, Portugal; Immunology Service, Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - Ana Martins Silva
- Neurology Service, Department of Neurosciences, Centro Hospitalar Universitário de Santo António, Porto, Portugal; Unit for Multidisciplinary Research in Biomedicine, Instituto de Ciências Biomédicas de Abel Salazar da Universidade do Porto, Porto, Portugal
| | - Maria José Sá
- Neurology Service, Centro Hospitalar Universitário São João, Porto, Portugal; Faculdade de Ciências da Saúde, Universidade de Fernando Pessoa, Porto, Portugal
| | - Ernestina Santos
- Neurology Service, Department of Neurosciences, Centro Hospitalar Universitário de Santo António, Porto, Portugal; Unit for Multidisciplinary Research in Biomedicine, Instituto de Ciências Biomédicas de Abel Salazar da Universidade do Porto, Porto, Portugal
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Rocha RB, Bomtempo FF, Tadinac ACB, Allioni GA, Silva GD, Telles JPM. Heterogenous relapse and efficacy endpoint definitions for neuromyelitis optica spectrum disorder studies: A systematic review. Mult Scler Relat Disord 2024; 91:105868. [PMID: 39260224 DOI: 10.1016/j.msard.2024.105868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 08/09/2024] [Accepted: 09/03/2024] [Indexed: 09/13/2024]
Abstract
BACKGROUND Over the last years, multiple studies have been dedicated to evaluate the efficacy of different treatment options for Neuromyelitis Optica Spectrum Disorder (NMOSD). However, there is a wide variety of endpoints employed across these studies. Our goal is to conduct a systematic review describing the endpoints utilized in studies related to NMOSD. METHODS Medline, Embase, and Cochrane were searched from inception to May 2023, to identify studies analyzing treatment options in patients with NMOSD. We collected data on baseline study characteristics and all efficacy outcomes available. RESULTS We included 127 studies and identified approximately 40 different efficacy endpoints, categorized into 1) relapse, 2) disability, 3) visual acuity, and 4) surrogate outcomes. Most studies were retrospective (54.3 %) and aimed at attack prevention (81.4 %). The most common relapse-related outcomes were annualized relapse rate (73.2 %), followed by relapse rate (50.4 %), and relapse-free rate (36.2 %). The relapse definition also varied widely among studies, with only 73 (57.4 %) studies explicitly addressing the definition used. The most common disability outcome was the Expanded Disability Scale (97.6 %), followed by the Modified Rankin Scale (7.9 %). Visual Acuity Score was employed in 14.2 % of studies, followed by Visual Evoked Potentials (6.3 %). Imaging was the most common surrogate (20.5 %), followed by the fraction of B cells (18.1 %). CONCLUSION Publications were heterogeneous in measuring efficacy, with different use of endpoints and relapse definitions. Standardization across studies would improve data analysis and application in clinical practice.
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Affiliation(s)
- Rebeka Bustamante Rocha
- School of Medicine, Federal University of Amazonas, R. Afonso Pena, 1053, Manaus, AM, 69020-160, Brazil.
| | - Fernanda Ferreira Bomtempo
- School of Medicine, Faculty of Medical Sciences of Minas Gerais, Alameda Ezequiel Dias, 275, Belo Horizonte, MG, 30130-110, Brazil
| | | | - Gabriela Abrahao Allioni
- Department of Neurology, University of São Paulo, Av. Dr. Enéas Carvalho de Aguiar 255, São Paulo, SP, 05403-000, Brazil
| | - Guilherme Diogo Silva
- Department of Neurology, University of São Paulo, Av. Dr. Enéas Carvalho de Aguiar 255, São Paulo, SP, 05403-000, Brazil
| | - João Paulo Mota Telles
- Department of Neurology, University of São Paulo, Av. Dr. Enéas Carvalho de Aguiar 255, São Paulo, SP, 05403-000, Brazil
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Shi Z, Kong L, Wang R, Wang X, Wang Z, Luo W, Chen H, Du Q, Sun D, Zhou H. Cytomegalovirus and Epstein-Barr virus infections in patients with neuromyelitis optica spectrum disorder. J Neurol 2024; 271:6089-6095. [PMID: 39046523 DOI: 10.1007/s00415-024-12571-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 06/23/2024] [Accepted: 06/28/2024] [Indexed: 07/25/2024]
Abstract
OBJECTIVES Cytomegalovirus (CMV) and Epstein-Barr virus (EBV) infections in patients with Neuromyelitis optica spectrum disorder (NMOSD) remain unclear. The objective of this study was to investigate CMV and EBV infections in patients with NMOSD. METHODS Serum immunoglobin (Ig) G antibodies against CMV and EBV were measured in patients with NMOSD and healthy controls (HCs), including anti-CMV, anti-EBV nuclear antigen-1 (EBNA-1), anti-EBV virus capsid antigen (VCA), and anti-EBV early antigen (EA) IgGs. The immune status ratio (ISR) was used to evaluate the serum anti-CMV and anti-EBV IgG levels and ISR ≧1.10 was defined as seropositivity. RESULTS In total, 238 serum samples were collected from 94 patients with NMOSD and 144 HCs, and no significant difference of sex and age between NMOSD and HCs. Comparing to the HCs, patients with NMOSD exhibited significantly higher serum anti-CMV IgG level. In contrast, the serum anti-EBNA1 IgG level was significantly lower in patients with NMOSD than in HCs. The serum anti-VCA and anti-EA IgG levels did not differ between the two groups, but the anti-EA seropositivity was significantly higher in NMOSD group than that in HC group. We did not find associations between serum anti-CMV or anti-EBV IgG levels and NMOSD disease stage, immunotherapy, or disability score. CONCLUSIONS Our findings indicated that increased CMV infection and EBV recent infection, as well as reduced EBV latency infection were associated with the risk of NMOSD. Prospective cohort studies are needed to verify our findings and clarify the correlation between CMV and EBV infections and clinical characteristics of NMOSD.
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Affiliation(s)
- Ziyan Shi
- Department of Neurology, West China Hospital, Sichuan University, Guo Xuexiang #37, Chengdu, 610041, China
| | - Lingyao Kong
- Department of Neurology, West China Hospital, Sichuan University, Guo Xuexiang #37, Chengdu, 610041, China
| | - Rui Wang
- Department of Neurology, West China Hospital, Sichuan University, Guo Xuexiang #37, Chengdu, 610041, China
| | - Xiaofei Wang
- Department of Neurology, West China Hospital, Sichuan University, Guo Xuexiang #37, Chengdu, 610041, China
| | - Ziya Wang
- Department of Neurology, West China Hospital, Sichuan University, Guo Xuexiang #37, Chengdu, 610041, China
| | - Wenqin Luo
- Department of Neurology, West China Hospital, Sichuan University, Guo Xuexiang #37, Chengdu, 610041, China
| | - Hongxi Chen
- Department of Neurology, West China Hospital, Sichuan University, Guo Xuexiang #37, Chengdu, 610041, China
| | - Qin Du
- Department of Neurology, West China Hospital, Sichuan University, Guo Xuexiang #37, Chengdu, 610041, China
| | - Dongren Sun
- Department of Neurology, West China Hospital, Sichuan University, Guo Xuexiang #37, Chengdu, 610041, China
| | - Hongyu Zhou
- Department of Neurology, West China Hospital, Sichuan University, Guo Xuexiang #37, Chengdu, 610041, China.
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Duchow A, Bellmann-Strobl J, Friede T, Aktas O, Angstwurm K, Ayzenberg I, Berthele A, Dawin E, Engels D, Fischer K, Flaskamp M, Giglhuber K, Grothe M, Havla J, Hümmert MW, Jarius S, Kaste M, Kern P, Kleiter I, Klotz L, Korporal-Kuhnke M, Kraemer M, Krumbholz M, Kümpfel T, Lohmann L, Ringelstein M, Rommer P, Schindler P, Schubert C, Schwake C, Senel M, Then Bergh F, Tkachenko D, Tumani H, Trebst C, Vardakas I, Walter A, Warnke C, Weber MS, Wickel J, Wildemann B, Winkelmann A, Paul F, Stellmann JP, Häußler V. Time to Disability Milestones and Annualized Relapse Rates in NMOSD and MOGAD. Ann Neurol 2024; 95:720-732. [PMID: 38086777 DOI: 10.1002/ana.26858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 12/07/2023] [Accepted: 12/08/2023] [Indexed: 01/14/2024]
Abstract
OBJECTIVE To investigate accumulation of disability in neuromyelitis optica spectrum disorder (NMOSD) and myelin oligodendrocyte glycoprotein-antibody-associated disease (MOGAD) in a changing treatment landscape. We aimed to identify risk factors for the development of disability milestones in relation to disease duration, number of attacks, and age. METHODS We analyzed data from individuals with NMOSD and MOGAD from the German Neuromyelitis Optica Study Group registry. Applying survival analyses, we estimated risk factors and computed time to disability milestones as defined by the Expanded Disability Status Score (EDSS). RESULTS We included 483 patients: 298 AQP4-IgG+ NMOSD, 52 AQP4-IgG-/MOG-IgG- NMOSD patients, and 133 patients with MOGAD. Despite comparable annualized attack rates, disability milestones occurred earlier and after less attacks in NMOSD patients than MOGAD patients (median time to EDSS 3: AQP4-IgG+ NMOSD 7.7 (95% CI 6.6-9.6) years, AQP4-IgG-/MOG-IgG- NMOSD 8.7) years, MOGAD 14.1 (95% CI 10.4-27.6) years; EDSS 4: 11.9 (95% CI 9.7-14.7), 11.6 (95% lower CI 7.6) and 20.4 (95% lower CI 14.1) years; EDSS 6: 20.1 (95% CI 16.5-32.1), 20.7 (95% lower CI 11.6), and 37.3 (95% lower CI 29.4) years; and EDSS 7: 34.2 (95% lower CI 31.1) for AQP4-IgG+ NMOSD). Higher age at onset increased the risk for all disability milestones, while risk of disability decreased over time. INTERPRETATION AQP4-IgG+ NMOSD, AQP4-IgG-/MOG-IgG- NMOSD, and MOGAD patients show distinctive relapse-associated disability progression, with MOGAD having a less severe disease course. Investigator-initiated research has led to increasing awareness and improved treatment strategies appearing to ameliorate disease outcomes for NMOSD and MOGAD. ANN NEUROL 2024;95:720-732.
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Affiliation(s)
- Ankelien Duchow
- Neuroscience Clinical Research Center, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Experimental and Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
| | - Judith Bellmann-Strobl
- Neuroscience Clinical Research Center, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Experimental and Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
| | - Tim Friede
- Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany
| | - Orhan Aktas
- Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Klemens Angstwurm
- Department of Neurology, University of Regensburg, Regensburg, Germany
| | - Ilya Ayzenberg
- Department of Neurology, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Achim Berthele
- Department of Neurology, School of Medicine, Technical University Munich, Klinikum rechts der Isar, Munich, Germany
| | - Eva Dawin
- Department of Neurology with Institute of translational Neurology, University of Münster, Münster, Germany
| | - Daniel Engels
- Institute of Clinical Neuroimmunology, LMU Hospital, Ludwig-Maximilians University Munich, Munich, Germany
| | - Katinka Fischer
- Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Martina Flaskamp
- Department of Neurology, School of Medicine, Technical University Munich, Klinikum rechts der Isar, Munich, Germany
| | - Katrin Giglhuber
- Department of Neurology, School of Medicine, Technical University Munich, Klinikum rechts der Isar, Munich, Germany
| | - Matthias Grothe
- Department of Neurology, University of Greifswald, Greifswald, Germany
| | - Joachim Havla
- Institute of Clinical Neuroimmunology, LMU Hospital, Ludwig-Maximilians University Munich, Munich, Germany
| | - Martin W Hümmert
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Sven Jarius
- Molecular Neuroimmunology Group, Department of Neurology, University of Heidelberg, Heidelberg, Germany
| | - Matthias Kaste
- Department of Neurology, Nordwest Hospital Sanderbusch, Sande, Germany
| | - Peter Kern
- Department of Neurology, Asklepios Expert Clinic Teupitz, Teupitz, Germany
| | - Ingo Kleiter
- Marianne-Strauß-Klinik, Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke, Berg, Germany
| | - Luisa Klotz
- Department of Neurology with Institute of translational Neurology, University of Münster, Münster, Germany
| | - Mirjam Korporal-Kuhnke
- Molecular Neuroimmunology Group, Department of Neurology, University of Heidelberg, Heidelberg, Germany
| | - Markus Kraemer
- Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- Department of Neurology, Alfried Krupp Hospital, Essen, Germany
| | - Markus Krumbholz
- Department of Neurology and Pain Treatment, Multiple Sclerosis Center, Center for Translational Medicine, Immanuel Klinik Rüdersdorf, University Hospital of the Brandenburg Medical School Theodor Fontane, Rüdersdorf bei Berlin, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Rüdersdorf bei Berlin, Germany
- Department of Neurology & Stroke, University Hospital of Tübingen, Tübingen, Germany
| | - Tania Kümpfel
- Institute of Clinical Neuroimmunology, LMU Hospital, Ludwig-Maximilians University Munich, Munich, Germany
| | - Lisa Lohmann
- Department of Neurology with Institute of translational Neurology, University of Münster, Münster, Germany
| | - Marius Ringelstein
- Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- Department of Neurology, Centre for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Paulus Rommer
- Department of Neurology, Medical University of Vienna, Vienna, Austria
- Department of Neurology, Rostock University Medical Center, Rostock, Germany
| | - Patrick Schindler
- Neuroscience Clinical Research Center, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Experimental and Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
| | - Charlotte Schubert
- Department of Neurology and Institute of Neuroimmunology and MS (INIMS), University Medical Center Hamburg -Eppendorf, Hamburg, Germany
| | - Carolin Schwake
- Department of Neurology, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Makbule Senel
- Department of Neurology, University of Ulm, Ulm, Germany
| | | | - Daria Tkachenko
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | | | - Corinna Trebst
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | | | - Annette Walter
- Department of Neurology, Herford Hospital, Herford, Germany
| | - Clemens Warnke
- Department of Neurology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Göttingen, Germany
| | - Martin S Weber
- Institute of Neuropathology, Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
- Fraunhofer Institute for Translational Medicine and, Pharmacology, Göttingen, Jena, Germany
| | - Jonathan Wickel
- Section of Translational Neuroimmunology, Department of Neurology, Jena University Hospital, Jena, Hamburg, Germany
| | - Brigitte Wildemann
- Molecular Neuroimmunology Group, Department of Neurology, University of Heidelberg, Heidelberg, Germany
| | | | - Friedemann Paul
- Neuroscience Clinical Research Center, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Experimental and Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
| | - Jan-Patrick Stellmann
- Department of Neurology and Institute of Neuroimmunology and MS (INIMS), University Medical Center Hamburg -Eppendorf, Hamburg, Germany
- APHM, Hopital de la Timone, CEMEREM, Marseille, France
- Aix Marseille Univ, CNRS, CRMBM, Marseille, France
| | - Vivien Häußler
- Department of Neurology and Institute of Neuroimmunology and MS (INIMS), University Medical Center Hamburg -Eppendorf, Hamburg, Germany
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Luo W, Wang X, Kong L, Chen H, Shi Z, Zhou H. Clinical features and prognosis of Tibetan patients with neuromyelitis optica spectrum disorder are different from those of Han Chinese patients. J Neuroimmunol 2024; 388:578263. [PMID: 38309224 DOI: 10.1016/j.jneuroim.2023.578263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 11/23/2023] [Accepted: 12/07/2023] [Indexed: 02/05/2024]
Abstract
We compared the prognosis of Tibetan and Han Chinese patients with neuromyelitis optica spectrum disorder (NMOSD). The Expanded Disability Status Scale (EDSS) score at each attack, response to immunosuppressive therapy, risk of first relapse, severe attack, visual disability, motor disability, and total risk of disability were compared between Tibetan and Han Chinese patients. Tibetan patients showed higher EDSS during acute attacks. Annualized relapse rate did not differ between groups. Risk of severe attack, visual disability, and total risk of disability were higher in Tibetan patients. Tibetan patients with NMOSD have a higher risk of poor prognosis than Han Chinese patients.
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Affiliation(s)
- Wenqin Luo
- Department of Neurology, West China Hospital, Sichuan University, No.37 Guo Xue Xiang, Chengdu 610041, Sichuan Province, PR China
| | - Xiaofei Wang
- Department of Neurology, West China Hospital, Sichuan University, No.37 Guo Xue Xiang, Chengdu 610041, Sichuan Province, PR China
| | - Lingyao Kong
- Department of Neurology, West China Hospital, Sichuan University, No.37 Guo Xue Xiang, Chengdu 610041, Sichuan Province, PR China
| | - Hongxi Chen
- Department of Neurology, West China Hospital, Sichuan University, No.37 Guo Xue Xiang, Chengdu 610041, Sichuan Province, PR China
| | - Ziyan Shi
- Department of Neurology, West China Hospital, Sichuan University, No.37 Guo Xue Xiang, Chengdu 610041, Sichuan Province, PR China.
| | - Hongyu Zhou
- Department of Neurology, West China Hospital, Sichuan University, No.37 Guo Xue Xiang, Chengdu 610041, Sichuan Province, PR China.
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Shi L, Li D, Zhang Y, Wang J, Fu J, Liu X, Wang P. Factors influencing the degree of disability in patients with neuromyelitis optica spectrum disorders. Eur J Med Res 2023; 28:426. [PMID: 37821922 PMCID: PMC10568753 DOI: 10.1186/s40001-023-01404-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 09/28/2023] [Indexed: 10/13/2023] Open
Abstract
OBJECTIVE To investigate the factors influencing the degree of disability in patients with neuromyelitis optica spectrum disorder (NMOSD) and provide evidence for disease monitoring and clinical intervention. METHODS Eighty-four patients with NMOSD at Xuanwu Hospital Capital Medical University were enrolled in this retrospective study. Before treatment, blood was collected from all patients, and their expanded disability status scores were assessed. RESULTS Of the 84 patients assessed, 66 (78.57%) had an expanded disability status scale score < 7, and 18 (21.43%) had scores ≥ 7. The univariate analysis showed that the total bilirubin (TBil), cerebrospinal fluid albumin (CSF ALB), cerebrospinal fluid immunoglobulin G (CSF IgG), QALB, and QIgG levels in the group with scores ≥ 7 were significantly different from those with scores < 7 (P < 0.05). In addition, Spearman's correlation analysis showed a significant correlation between ALB and expanded disability status scores in patients with NMOSD (P < 0.05), and the multivariate logistic regression analysis showed that TBil was an independent factor influencing the degree of disability in patients with NMOSD (P < 0.05). The receiver operating characteristic curve was constructed using TBil values; the area under the curve of TBil was 0.729 (P < 0.01), and the best cut-off value was 11.015 g/L. Its sensitivity in predicting the severity of disability in NMOSD patients was 51.5% while its specificity was 88.9%. CONCLUSION TBil is an independent factor that influences the severity of disability in patients with NMOSD. In addition, ALB is closely related to NMOSD severity, and some factors associated with the BBB are significantly increased in severely disabled NMOSD patients.
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Affiliation(s)
- Lili Shi
- Clinical Laboratory of Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Dawei Li
- Neurology of Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yunxiu Zhang
- Clinical Laboratory of Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jinling Wang
- Clinical Laboratory of Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jingxuan Fu
- Clinical Laboratory of Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xia Liu
- Clinical Laboratory of Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Peichang Wang
- Clinical Laboratory of Xuanwu Hospital, Capital Medical University, Beijing, China.
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Wang R, Sun DR, Du Q, Zhang Y, Chen HX, Wang XF, Kong LY, Luo WQ, Shi ZY, Zhou HY. Serum antinuclear antibodies associate with severe disease activity in neuromyelitis optica spectrum disorder. J Neuroimmunol 2023; 382:578151. [PMID: 37453208 DOI: 10.1016/j.jneuroim.2023.578151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 06/29/2023] [Accepted: 07/10/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Studies suggest that antinuclear antibodies (ANAs) may correlate with the long-term prognosis of Neuromyelitis optica spectrum disorder (NMOSD). In this study, we investigated ANAs in Chinese patients with NMOSD and their relationship with disease outcomes. METHODS We retrospectively collected data from 525 patients diagnosed with NMOSD at West China Hospital between September 1, 2009, and October 1, 2021. Patients were classified into two groups: NMOSD with ANA (+) or without ANA (-). We compared the clinical characteristics, relapse rate, severe attacks, laboratory tests, Expanded Disability Status Scale (EDSS), and prognosis between the two groups. RESULTS Among the 525 NMOSD patients, those with ANA showed a higher frequency of AQP4-IgG (94.1% vs 79.3%, p < 0.001, false discovery rate (FDR) corrected p < 0.001), and anti-SSA (p < 0.001, FDR corrected p < 0.001), anti-SSB (p < 0.001, FDR corrected p < 0.001), anti-Ro52 antibodies (p < 0.001, FDR corrected p < 0.001), than those without ANA. ANA was detected in 403 patients during the acute phase. Patients with ANA (+) had higher EDSS scores in the acute stage (4.0 vs. 3.75, p = 0.013, FDR corrected p = 0.029) and at final follow-up (p = 0.032, FDR corrected p = 0.064). NMOSD patients with ANA (+) had a higher frequency of severe acute myelitis attack, severe acute myelitis and optic neuritis attack, motor and visual disability, compared to those with ANA (-) (42.1% vs. 27.8%, p = 0.001, FDR corrected p = 0.004, 19.3% vs. 10.3%, p = 0.004, FDR corrected p = 0.018, and 11.1% vs. 4.8%, p = 0.008, FDR corrected p = 0.022 respectively). The two groups had no significant difference in the annual recurrence rate (ARR). CONCLUSION ANA may be associated with more severe disease activity and disability in NMOSD.
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Affiliation(s)
- Rui Wang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Dong Ren Sun
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Qin Du
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Ying Zhang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Hong Xi Chen
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Xiao Fei Wang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Ling Yao Kong
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Wen Qin Luo
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Zi Yan Shi
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.
| | - Hong Yu Zhou
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.
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Miao Y, Shi Z, Zhang W, Zhu L, Tang S, Chen H, Wang X, Du Q, Li S, Zhang Y, Luo W, Jin X, Fang M, Zhou H. Immune Repertoire Profiling Reveals Its Clinical Application Potential and Triggers for Neuromyelitis Optica Spectrum Disorders. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2023; 10:e200134. [PMID: 37414573 DOI: 10.1212/nxi.0000000000200134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 04/27/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND AND OBJECTIVES Neuromyelitis optica spectrum disorders (NMOSD) is widely recognized as a CNS demyelinating disease associated with AQP4-IgG (T cell-dependent antibody), and its trigger is still unclear. In addition, although the treatment of NMOSD currently can rely on traditional immunosuppressive and modulating agents, effective methods to predict the efficacy of these therapeutics are lacking. METHODS In this study, high-throughput T-cell receptor (TCR) sequencing was performed on peripheral blood from 151 pretreatment patients with AQP4-IgG+ NMOSD and 151 healthy individuals. We compared the TCR repertoire of those with NMOSD with that of healthy individuals and identified TCR clones that were significantly enriched in NMOSD. In addition, we treated 28 patients with AQP4-IgG+ NMOSD with immunosuppressants and followed up for 6 months to compare changes in NMOSD-specific TCRs (NMOSD-TCRs) before and after treatment. Moreover, we analyzed transcriptome and single-cell B-cell receptor (BCR) data from public databases and performed T-cell activation experiments using antigenic epitopes of cytomegalovirus (CMV) to further explore the triggers of AQP4-IgG+ NMOSD. RESULTS Compared with healthy controls, patients with AQP4-IgG+ NMOSD had significantly reduced diversity and shorter CDR3 length of TCRβ repertoire. Furthermore, we identified 597 NMOSD-TCRs with a high sequence similarity that have the potential to be used in the diagnosis and prognosis of NMOSD. The characterization of NMOSD-TCRs and pathology-associated clonotype annotation indicated that the occurrence of AQP4-IgG+ NMOSD may be associated with CMV infection, which was further corroborated by transcriptome and single-cell BCR analysis results from public databases and T-cell activation experiments. DISCUSSION Our findings suggest that the occurrence of AQP4-IgG+ NMOSD may be associated with CMV infection. In conclusion, our study provides new clues to uncover the causative factors of AQP4-IgG+ NMOSD and provides a theoretical foundation for treating and monitoring the disease.
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Affiliation(s)
- Yu Miao
- From the College of Life Sciences (M., X.J.), University of Chinese Academy of Sciences, Beijing; Department of Neurology (Z.S., L.Z., S.T., H.C., X.W., Q.D., Y.Z., W.L., M.F., H.Z.), West China Hospital, Sichuan University, Chengdu; and City University of Hong Kong (W.Z., S.L.), Shenzhen Research Institute, China
| | - Ziyan Shi
- From the College of Life Sciences (M., X.J.), University of Chinese Academy of Sciences, Beijing; Department of Neurology (Z.S., L.Z., S.T., H.C., X.W., Q.D., Y.Z., W.L., M.F., H.Z.), West China Hospital, Sichuan University, Chengdu; and City University of Hong Kong (W.Z., S.L.), Shenzhen Research Institute, China
| | - Wei Zhang
- From the College of Life Sciences (M., X.J.), University of Chinese Academy of Sciences, Beijing; Department of Neurology (Z.S., L.Z., S.T., H.C., X.W., Q.D., Y.Z., W.L., M.F., H.Z.), West China Hospital, Sichuan University, Chengdu; and City University of Hong Kong (W.Z., S.L.), Shenzhen Research Institute, China
| | - Lin Zhu
- From the College of Life Sciences (M., X.J.), University of Chinese Academy of Sciences, Beijing; Department of Neurology (Z.S., L.Z., S.T., H.C., X.W., Q.D., Y.Z., W.L., M.F., H.Z.), West China Hospital, Sichuan University, Chengdu; and City University of Hong Kong (W.Z., S.L.), Shenzhen Research Institute, China
| | - Shanshan Tang
- From the College of Life Sciences (M., X.J.), University of Chinese Academy of Sciences, Beijing; Department of Neurology (Z.S., L.Z., S.T., H.C., X.W., Q.D., Y.Z., W.L., M.F., H.Z.), West China Hospital, Sichuan University, Chengdu; and City University of Hong Kong (W.Z., S.L.), Shenzhen Research Institute, China
| | - Hongxi Chen
- From the College of Life Sciences (M., X.J.), University of Chinese Academy of Sciences, Beijing; Department of Neurology (Z.S., L.Z., S.T., H.C., X.W., Q.D., Y.Z., W.L., M.F., H.Z.), West China Hospital, Sichuan University, Chengdu; and City University of Hong Kong (W.Z., S.L.), Shenzhen Research Institute, China
| | - Xiaofei Wang
- From the College of Life Sciences (M., X.J.), University of Chinese Academy of Sciences, Beijing; Department of Neurology (Z.S., L.Z., S.T., H.C., X.W., Q.D., Y.Z., W.L., M.F., H.Z.), West China Hospital, Sichuan University, Chengdu; and City University of Hong Kong (W.Z., S.L.), Shenzhen Research Institute, China
| | - Qin Du
- From the College of Life Sciences (M., X.J.), University of Chinese Academy of Sciences, Beijing; Department of Neurology (Z.S., L.Z., S.T., H.C., X.W., Q.D., Y.Z., W.L., M.F., H.Z.), West China Hospital, Sichuan University, Chengdu; and City University of Hong Kong (W.Z., S.L.), Shenzhen Research Institute, China.
| | - Shuaicheng Li
- From the College of Life Sciences (M., X.J.), University of Chinese Academy of Sciences, Beijing; Department of Neurology (Z.S., L.Z., S.T., H.C., X.W., Q.D., Y.Z., W.L., M.F., H.Z.), West China Hospital, Sichuan University, Chengdu; and City University of Hong Kong (W.Z., S.L.), Shenzhen Research Institute, China.
| | - Ying Zhang
- From the College of Life Sciences (M., X.J.), University of Chinese Academy of Sciences, Beijing; Department of Neurology (Z.S., L.Z., S.T., H.C., X.W., Q.D., Y.Z., W.L., M.F., H.Z.), West China Hospital, Sichuan University, Chengdu; and City University of Hong Kong (W.Z., S.L.), Shenzhen Research Institute, China
| | - Wenqin Luo
- From the College of Life Sciences (M., X.J.), University of Chinese Academy of Sciences, Beijing; Department of Neurology (Z.S., L.Z., S.T., H.C., X.W., Q.D., Y.Z., W.L., M.F., H.Z.), West China Hospital, Sichuan University, Chengdu; and City University of Hong Kong (W.Z., S.L.), Shenzhen Research Institute, China
| | - Xin Jin
- From the College of Life Sciences (M., X.J.), University of Chinese Academy of Sciences, Beijing; Department of Neurology (Z.S., L.Z., S.T., H.C., X.W., Q.D., Y.Z., W.L., M.F., H.Z.), West China Hospital, Sichuan University, Chengdu; and City University of Hong Kong (W.Z., S.L.), Shenzhen Research Institute, China.
| | - Mingyan Fang
- From the College of Life Sciences (M., X.J.), University of Chinese Academy of Sciences, Beijing; Department of Neurology (Z.S., L.Z., S.T., H.C., X.W., Q.D., Y.Z., W.L., M.F., H.Z.), West China Hospital, Sichuan University, Chengdu; and City University of Hong Kong (W.Z., S.L.), Shenzhen Research Institute, China.
| | - Hongyu Zhou
- From the College of Life Sciences (M., X.J.), University of Chinese Academy of Sciences, Beijing; Department of Neurology (Z.S., L.Z., S.T., H.C., X.W., Q.D., Y.Z., W.L., M.F., H.Z.), West China Hospital, Sichuan University, Chengdu; and City University of Hong Kong (W.Z., S.L.), Shenzhen Research Institute, China.
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Lang Y, Kwapong WR, Kong L, Shi Z, Wang X, Du Q, Wu B, Zhou H. Retinal structural and microvascular changes in myelin oligodendrocyte glycoprotein antibody disease and neuromyelitis optica spectrum disorder: An OCT/OCTA study. Front Immunol 2023; 14:1029124. [PMID: 36793713 PMCID: PMC9923098 DOI: 10.3389/fimmu.2023.1029124] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 01/04/2023] [Indexed: 01/31/2023] Open
Abstract
Purpose To compare the optical coherence tomography (OCT)/OCT angiography (OCTA) measures in patients with neuromyelitis optica spectrum disorder (NMOSD) and myelin oligodendrocyte glycoprotein antibody disease (MOGAD). Methods Twenty-one MOG, 21 NMOSD, and 22 controls were enrolled in our study. The retinal structure [retinal nerve fiber layer (RNFL) and ganglion cell-inner plexiform layer (GCIPL)] was imaged and assessed with the OCT; OCTA was used to image the macula microvasculature [superficial vascular plexus (SVP), intermediate capillary plexus (ICP), and deep capillary plexus (DCP)]. Clinical information such as disease duration, visual acuity, and frequency of optic neuritis and disability was recorded for all patients. Results Compared with NMOSD patients, MOGAD patients showed significantly reduced SVP density (P = 0.023). No significant difference (P > 0.05) was seen in the microvasculature and structure when NMOSD-ON was compared with MOG-ON. In NMOSD patients, EDSS, disease duration, reduced visual acuity, and frequency of ON significantly correlated (P < 0.05) with SVP and ICP densities; in MOGAD patients, SVP correlated with EDSS, duration, reduced visual acuity, and frequency of ON (P < 0.05), while DCP density correlated with disease duration, visual acuity, and frequency of ON. Conclusions Distinct structural and microvascular changes were identified in MOGAD patients compared with NMOSD patients suggesting that the pathological mechanisms are different in NMOSD and MOGAD. Retinal imaging via the SS-OCT/OCTA might have the potential to be used as a clinical tool to evaluate the clinical features associated with NMOSD and MOGAD.
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Affiliation(s)
| | | | | | | | | | | | - Bo Wu
- *Correspondence: Hongyu Zhou, ; Bo Wu,
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10
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Krasnov VS, Bakhtiyarova KZ, Evdoshenko EP, Korobko DS, Simaniv TO, Totolyan NA, Khachanova NV, Shumilina MV, Davydovskaya MV. Consensus opinion on the management of patients with neuromyelitis optica spectrum diseases: issues of terminology and therapy. NEUROLOGY, NEUROPSYCHIATRY, PSYCHOSOMATICS 2022. [DOI: 10.14412/2074-2711-2022-6-139-148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- V. S. Krasnov
- Acad. I.P. Pavlov First Saint Petersburg State Medical University, Ministry of Health of Russia
| | | | - E. P. Evdoshenko
- City Center for Multiple Sclerosis, City Clinical Hospital Thirty-One
| | - D. S. Korobko
- Regional Center of Multiple Sclerosis and other Autoimmune Diseases of Nervous system, Novosibirsk State Regional Clinical Hospital; Novosibirsk State Medical University, Ministry of Health of Russia
| | | | - N. A. Totolyan
- Acad. I.P. Pavlov First Saint Petersburg State Medical University, Ministry of Health of Russia
| | - N. V. Khachanova
- N.I. Pirogov Russian National Research Medical University, Ministry of Health of Russia; Interdistrict Department of Multiple Sclerosis, City Clinical Hospital No 24, Moscow Healthcare Department
| | - M. V. Shumilina
- Acad. I.P. Pavlov First Saint Petersburg State Medical University, Ministry of Health of Russia; City Center for Multiple Sclerosis, City Clinical Hospital Thirty-One
| | - M. V. Davydovskaya
- N.I. Pirogov Russian National Research Medical University, Ministry of Health of Russia; Research and Practical Center for Clinical and Economic Analysis, Ministry of Health of the Moscow Region
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11
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Kong L, Wang X, Chen H, Shi Z, Lang Y, Zhang Y, Zhou H. Relapses after SARS-CoV-2 vaccination in patients with neuromyelitis optica spectrum disorder and multiple sclerosis. Mult Scler Relat Disord 2022; 68:104167. [PMID: 36170773 PMCID: PMC9472679 DOI: 10.1016/j.msard.2022.104167] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 08/19/2022] [Accepted: 09/08/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND The COVID-19 pandemic outbreak raises the question of whether immunization is recommended for patients with CNS demyelinating diseases. On the one hand, existing studies suggested that SARS-CoV-2 vaccinations are not associated with increased risk of relapse activity. On the other hand, case reports with acute CNS demyelinating disease post vaccination were emerging and raising clinicians' attention. METHODS In this longitudinal observational study, we included 556 patients with neuromyelitis optica spectrum disorder (NMOSD) and 280 patients with relapsing-remitting multiple sclerosis (RRMS). Each vaccinated patient was matched to two unvaccinated patients according to age, gender, ARR and immunotherapy status, based on propensity score matching model (PSM). The primary outcome is the short- and medium-term risk of relapse, which were evaluated by Kaplan-Meier analysis between groups. RESULTS In our cohort, 649 patients (77.6%) have not yet been vaccinated, mainly due to their concerns about relapse. After PSM, 109 vaccinated patients with NMOSD, 218 PS-matched unvaccinated patients with NMOSD, 78 vaccinated patients with RRMS, and 156 PS-matched unvaccinated patients with RRMS were included in the survival analysis to explore the safety of vaccines, with a median of 9-month follow-up. Following the first vaccination dose, 10 patients with NMOSD (9.2%) and four with RRMS (5.1%) experienced an acute relapse. Meanwhile, in the PS-matched unvaccinated group, 15 patients with NMOSD (6.9%) and 12 patients with RRMS (7.7%) presented with an acute relapse. There was no significant difference between the two curves in both NMOSD and RRMS groups over the course of the observation period. There were no significant differences in demographic characteristics, clinical characteristics, and symptoms of relapses between the vaccinated and PS-matched unvaccinated groups. Post vaccination adverse events (ADE) were reported in 39 individuals (20.9%). CONCLUSION Our results indicate that inactivated SARS-CoV-2 vaccines appear safe for patients with CNS demyelinating diseases.
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12
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Shi Z, Du Q, Wang X, Wang J, Chen H, Lang Y, Kong L, Luo W, Yang M, Zhou H. Granzyme B in circulating CD8+ T cells as a biomarker of immunotherapy effectiveness and disability in neuromyelitis optica spectrum disorders. Front Immunol 2022; 13:1027158. [PMID: 36439094 PMCID: PMC9682179 DOI: 10.3389/fimmu.2022.1027158] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 10/21/2022] [Indexed: 09/05/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Neuromyelitis optica spectrum disorders (NMOSD) are chronical inflammatory demyelinating diseases of the central nervous system (CNS) and the underlying mechanism remains unclear. Several recent studies have demonstrated that T cells play a pivotal role in the pathogenesis of NMOSD.In this study, we investigated CD8+ T cell phenotypes and levels of the cytotoxic protein granzyme B (GzmB), as well as their potential clinical application in NMOSD. METHODS In this study, 90 peripheral blood samples were collected from 59 NMOSD patients with seropositive anti-aquaporin-4 (AQP4) antibodies and 31 sex- and age-matched healthy donors (HDs). Flow cytometry was used to detect circulating levels of GzmB and CD8+ T cell subpopulations, including naïve (TN, CCD7+CD45RA+), central memory (TCM, CCD7+CD45RA-), effector memory (TEM, CCD7-CD45RA-), terminal differentiation effector memory cells (TEMRA, CCD7-CD45RA+) in both groups. The associations between GzmB levels in CD8+T cells and clinical characteristics of NMOSD were evaluated. RESULTS NMOSD patients exhibited significantly decreased proportions of CD8+TN cells and increased proportions of highly differentiated CD8+T cells (TEMRA) compared with HDs. In addition, levels of GzmB in CD8+ T cells were markedly higher in NMOSD patients than in HDs. Moreover, we observed that high proportions of GzmB-expressing CD8+ T cells were more common in patients with a poor response to immunotherapies, and showed a good potential to distinguish poor responders from responders (ACU=0.89). Clinical correlation analysis indicated that high levels of GzmB in CD8+ T cells were not only related to severe disability but also significantly associated with increased serum levels of neurofilament light (NFL) and glial fibrillary acidic protein (GFAP). Multivariate linear regression analyses further suggested that GzmB expression in CD8+ T cells was predominantly associated with disability and immunotherapy effectiveness in NMOSD, independent of the sex, age, and disease phase. Transcription factor T-bet in CD8+ T cells were also significantly elevated in NMOSD and were associated with increasing number of circulating CD8+TEMRA cells and GzmB-expressing CD8+T cells. CONCLUSIONS Our study support the involvement of GzmB-expressing CD8+ T cells in the inflammatory response in patients with NMOSD and provide a potential biomarker for disease immunotherapy effectiveness and disability progression.
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Affiliation(s)
- Ziyan Shi
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Qin Du
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaofei Wang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Jianchen Wang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Hongxi Chen
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Yanling Lang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Lingyao Kong
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Wenqin Luo
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Mu Yang
- Centre for Translational Research in Cancer, Sichuan Cancer Hospital & Institute, Chengdu, China
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Hongyu Zhou
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
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Xu X, Xie L, Wei L, Li M, Wang H, Zhou H, Sun M, Yang M, Xu Q, Yang K, Wei S. Efficacy and safety of monoclonal antibodies in neuromyelitis optica spectrum disorders: A survival meta-analysis of randomized controlled trials. ADVANCES IN OPHTHALMOLOGY PRACTICE AND RESEARCH 2022; 2:100064. [PMID: 37846287 PMCID: PMC10577852 DOI: 10.1016/j.aopr.2022.100064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 04/30/2022] [Accepted: 05/15/2022] [Indexed: 10/18/2023]
Abstract
Background Monoclonal antibodies such as rituximab (RTX), eculizumab, inebilizumab, satralizumab, and tocilizumab have been found to be effective therapies for neuromyelitis optica spectrum disease (NMOSD) in several clinical randomized controlled trials. Objective The purpose of this meta-analysis of randomized controlled trials was to assess the efficacy and safety of monoclonal antibodies in the treatment of NMOSD. Methods We searched the following databases for relevant English language literature from the establishment of the database to June 2021: PubMed, Embase, Cohorane Library, the Central Register of Controlled Trials (CENTRAL), and Web of Science. Randomized controlled trials of monoclonal antibodies were the targets of the review. Results We included seven trials containing 775 patients (485 in the monoclonal antibody group and 290 in the control group). Patients in the monoclonal group (HR 0.24, 95% CI: 0.14 to 0.40, P < 0.00001), as well as patients with seropositive AQP4-IgG (HR 0.18, 95% CI: 0.11 to 0.29, P < 0.00001), both had a higher free recurrence rate than that in the control group. In the first year (HR 0.25, 95% CI: 0.09 to 0.71, P = 0.009) and the second year (HR 0.32, 95% CI: 0.13 to 0.81, P = 0.02), no relapses were documented. The average changes of the expanded disability status scale (EDSS) score decreased by 0.29 (95% CI: -0.09 to 0.51, P = 0.005). Upper respiratory tract infection (OR 1.52, 95% CI: 0.76 to 3.04, P = 0.24), urinary tract infection(OR 0.79, 95% CI: 0.51 to 1.21, P = 0.27), and headache (OR 1.30, 95% CI: 0.78 to 2.17, P = 0.31) were three most frequent adverse reactions. Conclusions Monoclonal antibodies are particularly effective treatments in avoiding recurrence for NMOSD patients, according to this meta-analysis. The associated adverse responses are not significantly different from those seen with traditional immunosuppressants.
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Affiliation(s)
- Xintong Xu
- Medical School of Chinese PLA, Beijing, China
- Department of Ophthalmology, Chinese PLA General Hospital, Beijing, China
| | - Lindan Xie
- Department of Ophthalmology, Chinese PLA General Hospital, Beijing, China
| | - Lili Wei
- Evidence-Based Medicine Center, Lanzhou University, Lanzhou, China
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
- Gansu Medical Guideline Technology Center, Lanzhou University, Lanzhou, China
| | - Meixuan Li
- Evidence-Based Medicine Center, Lanzhou University, Lanzhou, China
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
- Gansu Medical Guideline Technology Center, Lanzhou University, Lanzhou, China
| | - Hao Wang
- Department of Ophthalmology, Lanzhou University Second Hospital, Lanzhou, China
| | - Huanfen Zhou
- Department of Ophthalmology, Chinese PLA General Hospital, Beijing, China
| | - Mingming Sun
- Department of Ophthalmology, Chinese PLA General Hospital, Beijing, China
| | - Mo Yang
- Department of Ophthalmology, Chinese PLA General Hospital, Beijing, China
| | - Quangang Xu
- Department of Ophthalmology, Chinese PLA General Hospital, Beijing, China
| | - Kehu Yang
- Evidence-Based Medicine Center, Lanzhou University, Lanzhou, China
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
- Gansu Medical Guideline Technology Center, Lanzhou University, Lanzhou, China
| | - Shihui Wei
- Department of Ophthalmology, Chinese PLA General Hospital, Beijing, China
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Wang X, Kong L, Zhao Z, Shi Z, Chen H, Lang Y, Lin X, Du Q, Zhou H. Effectiveness and tolerability of different therapies in preventive treatment of MOG-IgG-associated disorder: A network meta-analysis. Front Immunol 2022; 13:953993. [PMID: 35958613 PMCID: PMC9360318 DOI: 10.3389/fimmu.2022.953993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 06/28/2022] [Indexed: 11/13/2022] Open
Abstract
Background Immunotherapy has been shown to reduce relapses in patients with myelin oligodendrocyte glycoprotein antibody-associated disorder (MOG-AD); however, the superiority of specific treatments remains unclear. Aim To identify the efficacy and tolerability of different treatments for MOG-AD. Methods Systematic search in Pubmed, Embase, Web of Science, and Cochrane Library databases from inception to March 1, 2021, were performed. Published articles including patients with MOG-AD and reporting the efficacy or tolerability of two or more types of treatment in preventing relapses were included. Reported outcomes including incidence of relapse, annualized relapse rate (ARR), and side effects were extracted. Network meta-analysis with a random-effect model within a Bayesian framework was conducted. Between group comparisons were estimated using Odds ratio (OR) or mean difference (MD) with 95% credible intervals (CrI). Results Twelve studies that compared the efficacy of 10 different treatments in preventing MOG-AD relapse, including 735 patients, were analyzed. In terms of incidence of relapse, intravenous immunoglobulins (IVIG), oral corticosteroids (OC), mycophenolate mofetil (MMF), azathioprine (AZA), and rituximab (RTX) were all significantly more effective than no treatment (ORs ranged from 0.075 to 0.34). On the contrary, disease-modifying therapy (DMT) (OR=1.3, 95% CrI: 0.31 to 5.0) and tacrolimus (TAC) (OR=5.9, 95% CrI: 0.19 to 310) would increase the incidence of relapse. Compared with DMT, IVIG significantly reduced the ARR (MD=-0.85, 95% CrI: -1.7 to -0.098). AZA, MMF, OC and RTX showed a trend to decrease ARR, but those results did not reach significant differences. The combined results for relapse rate and adverse events, as well as ARR and adverse events showed that IVIG and OC were the most effective and tolerable therapies. Conclusions Whilst DMT should be avoided, IVIG and OC may be suited as first-line therapies for patients with MOG-AD. RTX, MMF, and AZA present suitable alternatives.
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Affiliation(s)
- Xiaofei Wang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Lingyao Kong
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Zhengyang Zhao
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
- Mental Health Centre and Psychiatric Laboratory, West China Hospital, Sichuan University, Chengdu, China
| | - Ziyan Shi
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Hongxi Chen
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Yanlin Lang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Xue Lin
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Qin Du
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Hongyu Zhou
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
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15
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Comparison on the effect of seven drugs to prevent relapses of neuromyelitis optica spectrum disorders: A modeling analysis of literature aggregate data. Int Immunopharmacol 2022; 110:109004. [PMID: 35785726 DOI: 10.1016/j.intimp.2022.109004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 05/30/2022] [Accepted: 06/23/2022] [Indexed: 01/09/2023]
Abstract
BACKGROUND Neuromyelitis optica spectrum disorders (NMOSD) is an immune-mediated demyelinating disease of the central nervous system. This study aimed to perform a comprehensive comparison of the effect of seven drugs to prevent relapses of NMOSD. METHOD A literature search was conducted using public databases. Clinical studies on the seven drugs (eculizumab, inebilizumab, satralizumab, rituximab, tocilizumab, azathioprine, and mycophenolate mofetil) to prevent relapses of NMOSD were identified. A time-course model was established using the time to first relapse as the primary endpoint, in order to evaluate the long-term effect of each drug in preventing relapse. RESULTS Twenty-four trials, including 2207 patients, were included in the model analysis. The results showed that monoclonal antibody therapy could significantly prolong the time to first relapse. Among all seven drugs, eculizumab can most significantly prevent patient from relapse. The estimated proportion of relapse-free patients treated with eculizumab was 98.9% at 24 months. CONCLUSION Based on the construction of a time-course pharmacodynamic model, this study made a comprehensive quantitative comparison of seven drugs for the treatment of NMOSD for the first time. These results can not only serve as a quantitative supplement for the rational use of drugs in clinical practice but also provide a pharmacodynamic reference for clinical trial design and decision making in the future.
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16
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Shi M, Chu F, Jin T, Zhu J. Progress in treatment of neuromyelitis optica spectrum disorders (NMOSD): Novel insights into therapeutic possibilities in NMOSD. CNS Neurosci Ther 2022; 28:981-991. [PMID: 35426485 PMCID: PMC9160456 DOI: 10.1111/cns.13836] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 03/18/2022] [Accepted: 03/24/2022] [Indexed: 11/29/2022] Open
Abstract
Neuromyelitis optica spectrum disorder (NMOSD) is a rare autoimmune inflammatory demyelinating disorder of the central nervous system (CNS), which is a severely disabling disorder leading to devastating sequelae or even death. Repeated acute attacks and the presence of aquaporin-4 immunoglobulin G (AQP4-IgG) antibody are the typical characteristics of NMOSD. Recently, the phase III trials of the newly developed biologicals therapies have shown their effectiveness and good tolerance to a certain extent when compared with the traditional therapy with the first- and second-line drugs. However, there is still a lack of large sample, double-blind, randomized, clinical studies to confirm their efficacy, safety, and tolerability. Especially, these drugs have no clear effect on NMOSD patients without AQP4-IgG and refractory patients. Therefore, it is of strong demand to further conduct large sample, double-blind, randomized, clinical trials, and novel therapeutic possibilities in NMOSD are discussed briefly here.
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Affiliation(s)
- Mingchao Shi
- Neuroscience CenterDepartment of NeurologyThe First Hospital of Jilin UniversityChangchunChina
- Department of Neurobiology, Care Sciences & SocietyDivision of NeurogeriatrcsKarolinska InstitutetKarolinska University Hospital SolnaStockholmSweden
| | - Fengna Chu
- Neuroscience CenterDepartment of NeurologyThe First Hospital of Jilin UniversityChangchunChina
- Department of Neurobiology, Care Sciences & SocietyDivision of NeurogeriatrcsKarolinska InstitutetKarolinska University Hospital SolnaStockholmSweden
| | - Tao Jin
- Neuroscience CenterDepartment of NeurologyThe First Hospital of Jilin UniversityChangchunChina
| | - Jie Zhu
- Neuroscience CenterDepartment of NeurologyThe First Hospital of Jilin UniversityChangchunChina
- Department of Neurobiology, Care Sciences & SocietyDivision of NeurogeriatrcsKarolinska InstitutetKarolinska University Hospital SolnaStockholmSweden
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17
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Huang W, Wang L, Xia J, Li W, Wang M, Yu J, Li Q, Wang B, Pan J, Du L, Ma J, Tan H, Chang X, Lu C, Zhao C, Lu J, Zhou L, ZhangBao J, Quan C. Efficacy and safety of azathioprine, mycophenolate mofetil and reduced dose of rituximab in neuromyelitis optica spectrum disorder. Eur J Neurol 2022; 29:2343-2354. [PMID: 35398950 DOI: 10.1111/ene.15355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 04/05/2022] [Indexed: 12/01/2022]
Affiliation(s)
- Wenjuan Huang
- Department of Neurology Huashan Hospital Shanghai Medical College Fudan University Shanghai China
- National Center for Neurological Disorders (NCND) Shanghai China
- Huashan Rare Disease Center Huashan Hospital Shanghai Medical College Fudan University Shanghai China
| | - Liang Wang
- Department of Neurology Huashan Hospital Shanghai Medical College Fudan University Shanghai China
- National Center for Neurological Disorders (NCND) Shanghai China
- Huashan Rare Disease Center Huashan Hospital Shanghai Medical College Fudan University Shanghai China
| | - Junhui Xia
- Department of Neurology The First Affiliated Hospital of Wenzhou Medical University Wenzhou Zhejiang Province China
| | - Wenyu Li
- Department of Neurology Sir Run Run Shaw Hospital School of Medicine Zhejiang University Hangzhou Zhejiang Province China
| | - Min Wang
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital Fudan University Shanghai China
| | - Jian Yu
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital Fudan University Shanghai China
| | - Qinying Li
- Department of Rehabilitation Medicine Jing’an District Centre Hospital of Shanghai Fudan University Shanghai 200040 China
| | - Bei Wang
- Department of Neurology Jing’an District Centre Hospital of Shanghai Fudan University Shanghai 200040 China
| | - Juyuan Pan
- Department of Neurology The First Affiliated Hospital of Wenzhou Medical University Wenzhou Zhejiang Province China
| | - Lei Du
- Department of Neurology The First Affiliated Hospital of Xinjiang Medical University Urumqi Xinjiang Uygur Autonomous Region China
| | - Jianhua Ma
- Department of Neurology The First Affiliated Hospital of Xinjiang Medical University Urumqi Xinjiang Uygur Autonomous Region China
| | - Hongmei Tan
- Department of Neurology Huashan Hospital Shanghai Medical College Fudan University Shanghai China
- National Center for Neurological Disorders (NCND) Shanghai China
- Huashan Rare Disease Center Huashan Hospital Shanghai Medical College Fudan University Shanghai China
| | - Xuechun Chang
- Department of Neurology Huashan Hospital Shanghai Medical College Fudan University Shanghai China
- National Center for Neurological Disorders (NCND) Shanghai China
- Huashan Rare Disease Center Huashan Hospital Shanghai Medical College Fudan University Shanghai China
| | - Chuanzhen Lu
- Department of Neurology Huashan Hospital Shanghai Medical College Fudan University Shanghai China
- National Center for Neurological Disorders (NCND) Shanghai China
- Huashan Rare Disease Center Huashan Hospital Shanghai Medical College Fudan University Shanghai China
| | - Chongbo Zhao
- Department of Neurology Huashan Hospital Shanghai Medical College Fudan University Shanghai China
- National Center for Neurological Disorders (NCND) Shanghai China
- Huashan Rare Disease Center Huashan Hospital Shanghai Medical College Fudan University Shanghai China
| | - Jiahong Lu
- Department of Neurology Huashan Hospital Shanghai Medical College Fudan University Shanghai China
- National Center for Neurological Disorders (NCND) Shanghai China
- Huashan Rare Disease Center Huashan Hospital Shanghai Medical College Fudan University Shanghai China
| | - Lei Zhou
- Department of Neurology Huashan Hospital Shanghai Medical College Fudan University Shanghai China
- National Center for Neurological Disorders (NCND) Shanghai China
- Huashan Rare Disease Center Huashan Hospital Shanghai Medical College Fudan University Shanghai China
| | - Jingzi ZhangBao
- Department of Neurology Huashan Hospital Shanghai Medical College Fudan University Shanghai China
- National Center for Neurological Disorders (NCND) Shanghai China
- Huashan Rare Disease Center Huashan Hospital Shanghai Medical College Fudan University Shanghai China
| | - Chao Quan
- Department of Neurology Huashan Hospital Shanghai Medical College Fudan University Shanghai China
- National Center for Neurological Disorders (NCND) Shanghai China
- Huashan Rare Disease Center Huashan Hospital Shanghai Medical College Fudan University Shanghai China
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18
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Carnero Contentti E, López PA, Rojas JI. Emerging drugs for the acute treatment of relapses in adult neuromyelitis optica spectrum disorder patients. Expert Opin Emerg Drugs 2022; 27:91-98. [PMID: 35341428 DOI: 10.1080/14728214.2022.2059463] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Neuromyelitis optica spectrum disorders (NMOSD) are rare but often devastating neuroinflammatory autoimmune diseases of the central nervous system. Acute treatment is critically important and it should be initiated early and aggressively, as relapses result in severe residual disability. Acute treatments are still based on clinical experience and observational studies. The most commonly used treatments are steroids and plasmapheresis. Several new treatments to improve management and recovery after relapses in NMOSD are currently under investigation. AREAS COVERED : This review discusses current and the most recent advances in active development of phase II/III clinical trials for acute treatment options and therapeutic strategies that can help management improvement of NMOSD during a relapse. These treatments include bevacizumab, ublituximab and HBM9161. EXPERT OPINION NMOSD relapses require prompt evaluation and timely treatment to restore function and mitigate disability. Timing is critical. Plasmapheresis showed better outcomes in terms of recovery when compared to high-dose intravenous methylprednisolone alone. Some groups suggest that plasmapheresis could be considered as an initial treatment approach in different clinical scenarios due to its higher effectiveness. Future research and/or real-world data will establish the advantages and disadvantages of these new treatments and define the appropriate patient profile.
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Affiliation(s)
| | - Pablo A López
- Neuroimmunology Unit, Department of Neuroscience, Hospital Aleman, Buenos Aires, Argentina
| | - Juan I Rojas
- Centro de Esclerosis Múltiple de Buenos Aires (CEMBA), Buenos Aires, Argentina.,Servicio de Neurología, Hospital Universitario de CEMIC, Buenos Aires, Argentina
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19
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Ma J, Yu H, Wang H, Zhang X, Feng K. Evaluation of effect of empirical attack-preventive immunotherapies in neuromyelitis optica spectrum disorders: An update systematic review and meta -analysis. J Neuroimmunol 2021; 363:577790. [PMID: 34959021 DOI: 10.1016/j.jneuroim.2021.577790] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 11/28/2021] [Accepted: 12/11/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Neuromyelitis optica spectrum disorder (NMOSD) is an inflammatory disease of the central nervous system, which mainly involves the optic nerve and spinal cord. Frequent relapse can accumulate the degree of disability. At present, the main treatment options are immunosuppressants and blood purification. The first-line immunosuppressants for NMOSD are mainly rituximab (RTX), mycophenolate mofetil (MMF) and azathioprine (AZA). Therefore, we designed this systematic review and meta-analysis to evaluate the safety and effect of the above three drugs in the treatment of NMOSD patients. METHODS The following Medical Subject Heading (MeSH) and related entry terms are used to search English literature in PubMed, MEDLINE and CENTRAL databases, respectively. MeSH include: Neuromyelitis optic and Rituximab or Azathioprine or Mycophenolate Mofetil; entry terms include: NMO Spectrum Disorder, NMO Spectrum Disorders, Neuromyelitis Optica (NMO) Spectrum Disorder, Neuromyelitis Optica Spectrum Disorders, Devic Neuromyelitis Optica, Neuromyelitis Optica, Devic, Devic's Disease, Devic Syndrome, Devic's Neuromyelitis Optica, Neuromyelitis Optica (NMO) Spectrum Disorders, CD20 Antibody, Rituximab CD20 Antibody, Mabthera, IDEC-C2B8 Antibody, GP2013, Rituxan, Mycophenolate Mofetil, Mofetil, Mycophenolate, Mycophenolic Acid, Morpholinoethyl Ester, Cellcept, Mycophenolate Sodium, Myfortic, Mycophenolate Mofetil Hydrochloride, Mofetil Hydrochloride, Mycophenolate, RS 61443, RS-61443, RS61443, azathioprine sodium, azathioprine sulfate (note: literature retrieval operators "AND" "OR" "NOT" are used to link MeSH with Entry Terms.) The literature search found a total of 3058 articles about rituximab, mycophenolate mofetil and azathioprine in the treatment of NMOSD, 63 of which were included in this study after a series of screening. RESULTS 930,933,732 patients with NMOSD were enrolled, who had been treated with MMF, AZA and RTX, respectively. The pooled standardized mean difference (SMD) of EDSS before and after RTX treated was -0.58 (95%CI: -0.72, -0.44) (I2 = 0%, p = 0.477), before and after MMF treated was -0.47 (95%CI: -0.73, -0.21) (I2 = 85.6%, p<0.001), before and after AZA treated was -0.41 (95%CI: -0.60, -0.23) (I2 = 65.4%, p<0.001). there was no significant difference in the effect of the three drugs on reducing EDSS scores (RTX vs MMF, p = 0.522; RTX vs AZA, p = 0.214; MMF vs AZA, p = 0.732). The pooled standardized mean difference (SMD) of ARR before and after RTX treated was -1.45 (95%CI: -1.72, -1.18) (I2 = 72.4%, p<0.001), before and after MMF treated was -1.14 (95%CI: -1.31, -0.97) (I2 = 54.5%, p<0.001), before and after AZA treated was -1.11 (95%CI: -1.39, -0.83) (I2 = 83.4%, p<0.001). RTX significantly reduced ARR compared with the other two drugs (RTX vs MMF, p = 0.039; RTX vs AZA, p = 0.049; MMF vs AZA, p = 0.436). CONCLUSION The results of this systematic review and meta-analysis showed that the treatment of NMOSD patients with RTX, MMF and AZA is associated with decreased number of relapses and disability improvement as well, and there was no significant difference in the effect of the three drugs on reducing EDSS scores, but RTX significantly reduced ARR compared with the other two drugs.
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Affiliation(s)
- Jia Ma
- Department of Neurology, Beijing Shunyi Hospital, NO.3 Guangming South Street, Shunyi District, Beijing 101300, China; Department of Neurology, Beijing Tiantan Hospital, China National Clinical Research Center for Neurological Diseases, Capital Medical University, No.119 South 4th Ring West Road, Fengtai District, Beijing 100160, China
| | - Haihua Yu
- Department of Neurology, Beijing Shunyi Hospital, NO.3 Guangming South Street, Shunyi District, Beijing 101300, China
| | - Hao Wang
- Department of Neurology, Beijing Shunyi Hospital, NO.3 Guangming South Street, Shunyi District, Beijing 101300, China
| | - Xinghu Zhang
- Department of Neurology, Beijing Tiantan Hospital, China National Clinical Research Center for Neurological Diseases, Capital Medical University, No.119 South 4th Ring West Road, Fengtai District, Beijing 100160, China.
| | - Kai Feng
- Department of Neurology, Beijing Shunyi Hospital, NO.3 Guangming South Street, Shunyi District, Beijing 101300, China.
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20
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Zhang J, Li Y, Zhou Y, Wang K, Pan C, Zhao Y, Xie H, Duan R, Gong Z, Jia Y. Monocyte to High-Density Lipoprotein Ratio: A Novel Predictive Marker of Disease Severity and Prognosis in Patients With Neuromyelitis Optica Spectrum Disorders. Front Neurol 2021; 12:763793. [PMID: 34777231 PMCID: PMC8580507 DOI: 10.3389/fneur.2021.763793] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 09/28/2021] [Indexed: 01/04/2023] Open
Abstract
Background and Purpose: To investigate the association of monocyte to high-density lipoprotein ratio (MHR) with disease severity and prognosis in patients with neuromyelitis optica spectrum disorders (NMOSD). Methods: This retrospective study included 125 patients with NMOSD. Demographic and clinical parameters, including the MHR, were assessed. The initial Expanded Disability Status Scale (EDSS) score and relapse rate were used to evaluate disease severity and prognosis, respectively. Correlations between MHR and disease severity and relapse rate were analyzed. The predictive value of MHR for prognosis was evaluated using receiver operating characteristic (ROC) curve analysis. Results: Compared with the low MHR group, the initial EDSS score (median 4.5 vs. 5.5%, P = 0.025) and relapse rate (51.61 vs. 30.16%, P = 0.015) were significantly higher in the high MHR group. MHR was positively correlated with the initial EDSS score (r = 0.306, P = 0.001). Multivariate analysis showed that MHR was significantly associated with severity (odds ratio = 7.90, 95% confidence interval [CI] = 1.08–57.82, P = 0.041), and it was a significant predictor of disease prognosis (hazard ratio = 3.12, 95% CI = 1.02–9.53, P = 0.046). The median relapse interval of the high MHR group was 24.40 months. When the MHR was higher than 0.565, the risk of relapse was high [sensitivity, 33.3%; specificity, 91.9%; area under the ROC curve, 0.642 (95% CI = 0.54–0.74, P = 0.007)]. Conclusion: MHR is a novel predictive marker of disease severity and prognosis in patients with NMOSD. Early monitoring and reduction of MHR may allow earlier intervention and improved prognosis.
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Affiliation(s)
- Jinwei Zhang
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yanfei Li
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yongyan Zhou
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Kaixin Wang
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Chunyang Pan
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yi Zhao
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Haojie Xie
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ranran Duan
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhe Gong
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yanjie Jia
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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21
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Jia Z, Dong X, Song S, Guo R, Zhang L, Liu J, Li B. Physical, Emotional, Medical, and Socioeconomic Status of Patients With NMOSD: A Cross-Sectional Survey of 123 Cases From a Single Center in North China. Front Neurol 2021; 12:737564. [PMID: 34566879 PMCID: PMC8455822 DOI: 10.3389/fneur.2021.737564] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 08/16/2021] [Indexed: 12/17/2022] Open
Abstract
Objective: This study aimed to assess the physical, emotional, medical, and socioeconomic conditions of patients with neuromyelitis optica spectrum disorder (NMOSD) in North China. Methods: A cross-sectional survey of patients with NMOSD was performed, based on an established questionnaire from the Multiple Sclerosis Patient Survival Report 2018. Logistic regression analysis was conducted to define the significant determinants of certain physical or emotional characteristics of patients. A total of 123 patients were included. Results: A total of 63.4% of participants were initially diagnosed with conditions other than NMOSD, with a median delay of 6 months for accurate diagnosis. An aggregate of 72.2% of patients had one or more relapses, corresponding to an annual relapse rate of 0.8. Paresthesia was the most frequent physical symptom among patients both at disease onset (53.7%) and throughout the duration of the disease (86.2%). Onset in elderly (>50 years) patients was associated with an annual Expanded Disability Status Scale increase ≥1, compared with onset in younger (<30 years) patients (P = 0.001, OR = 7.83). A total of 76.4% of patients had received attack-prevention treatments in the remission phase, and 31.7 and 10.6% of patients had ever been administered rituximab and traditional Chinese medicine, respectively. Additionally, 63.4 and 43.1% of patients reported participating in few or no social activities and being out of work because of the disease. To be noted, 76.4% of patients reported suffering from negative emotions, with the most frequent being worry (60.2%), with 20.3% of patients experiencing suicidal thoughts. The inability to work and participating in few or no social activities due to NMOSD were two determinants of experiencing negative emotions (Pwork = 0.03, ORwork = 3.34; Psocialactivities = 0.02, ORsocialactivities = 3.19). Conclusion: This study reported patient perspectives on NMOSD in North China, whereby demonstrating that the inability to work and participating in few or no social activities due to NMOSD rather than the physical impairment caused by the disease, was directly associated with patients experiencing negative emotions. This insight offers potential ways to manage patients' negative emotions by enhancing family and social support and facilitating active employment.
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Affiliation(s)
- Zhen Jia
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, China.,Neurological Laboratory of Hebei, Shijiazhuang, China
| | - XiuYu Dong
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, China.,Neurological Laboratory of Hebei, Shijiazhuang, China
| | - Shuang Song
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, China.,Neurological Laboratory of Hebei, Shijiazhuang, China
| | - Ruoyi Guo
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, China.,Neurological Laboratory of Hebei, Shijiazhuang, China
| | - Lu Zhang
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, China.,Neurological Laboratory of Hebei, Shijiazhuang, China
| | - Jia Liu
- Department of Neurology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China.,Institute for Brain Disorders, Beijing University of Chinese Medicine, Beijing, China
| | - Bin Li
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, China.,Neurological Laboratory of Hebei, Shijiazhuang, China
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22
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Zhang L, Tian J, Dong X, Jia Z, Sun Y, Guo L, Tan G, Li B. Efficacy of azathioprine, mycophenolate mofetil, and rituximab in the treatment of neuromyelitis optica spectrum disorder and analysis of prognostic factors. Neurol Sci 2021; 43:2651-2658. [PMID: 34585292 DOI: 10.1007/s10072-021-05609-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 09/10/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The study aims to compare the efficacies of the immunosuppressants most commonly prescribed for patients with neuromyelitis optica spectrum disorder (NMOSD). The predictors, which might be associated with relapse and disability in NMOSD, were also analyzed. METHODS This retrospective study included NMOSD patients treated with azathioprine (AZA), mycophenolate mofetil (MMF), and rituximab (RTX). The annual relapse rate (ARR) and the incidence rates of adverse events were compared. Cox proportional-hazards model calculated the potential predictors of NMOSD relapse and disability. RESULTS A total of 83 patients were included. The median treatment time of AZA group (n = 34), MMF group (n = 20), and RTX group (n = 29) were 19.5, 15.5, and 12 months, respectively. ARR of the three groups reduced significantly after treatment. In the three groups, 55.9%, 50%, and 79.3% of patients, respectively, were free from relapse. However, the difference among the three groups was of no statistical significance, possibly due to the small sample size. During the treatment, 32.4%, 15%, and 24.1% of patients experienced adverse events in the AZA group, MMF group, and RTX group, respectively. Additionally, the multivariate Cox analyses indicated that history of a severe attack and disease duration were associated with the risk of relapse after immunotherapy. Late-onset (≥ 50 years old) NMOSD patients were probably more susceptible to motor disability, and those with optic neuritis at onset were more likely to develop visual disability. CONCLUSIONS AZA, MMF, and low-dose RTX were all effective in reducing the relapse rate in NMOSD. The age at onset, disease duration, history of severe attacks, and primary syndromes might be significant prognostic predictors in NMOSD.
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Affiliation(s)
- Lu Zhang
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000, Hebei, China.,Key Laboratory of Hebei Neurology, Shijiazhuang, 050000, Hebei, China
| | - Jingyuan Tian
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000, Hebei, China.,Key Laboratory of Hebei Neurology, Shijiazhuang, 050000, Hebei, China
| | - Xiuyu Dong
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000, Hebei, China.,Key Laboratory of Hebei Neurology, Shijiazhuang, 050000, Hebei, China
| | - Zhen Jia
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000, Hebei, China.,Key Laboratory of Hebei Neurology, Shijiazhuang, 050000, Hebei, China
| | - Yafei Sun
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000, Hebei, China.,Key Laboratory of Hebei Neurology, Shijiazhuang, 050000, Hebei, China
| | - Li Guo
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000, Hebei, China.,Key Laboratory of Hebei Neurology, Shijiazhuang, 050000, Hebei, China
| | - Guojun Tan
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000, Hebei, China. .,Key Laboratory of Hebei Neurology, Shijiazhuang, 050000, Hebei, China.
| | - Bin Li
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, 050000, Hebei, China. .,Key Laboratory of Hebei Neurology, Shijiazhuang, 050000, Hebei, China.
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23
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Giovannelli J, Ciron J, Cohen M, Kim HJ, Kim SH, Stellmann JP, Kleiter I, McCreary M, Greenberg BM, Deschamps R, Audoin B, Maillart E, Papeix C, Collongues N, Bourre B, Laplaud D, Ayrignac X, Durand-Dubief F, Ruet A, Vukusic S, Marignier R, Dauchet L, Zephir H. A meta-analysis comparing first-line immunosuppressants in neuromyelitis optica. Ann Clin Transl Neurol 2021; 8:2025-2037. [PMID: 34505407 PMCID: PMC8528466 DOI: 10.1002/acn3.51451] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 08/18/2021] [Indexed: 12/19/2022] Open
Abstract
Objective As phase III trials have shown interest in innovative but expensive drugs in the treatment of neuromyelitis optica spectrum disorder (NMOSD), data are needed to clarify strategies in the treatment of neuromyelitis optica (NMO). This meta‐analysis compares the efficacy of first‐line strategies using rituximab (RTX), mycophenolate mofetil (MMF), or azathioprine (AZA), which are still widely used. Methods Studies identified by the systematic review of Huang et al. (2019) were selected if they considered at least two first‐line immunosuppressants among RTX, MMF, and AZA. We updated this review. The Medline, Cochrane Central Register of Controlled Trials, Embase, and ClinicalTrials databases were queried between November 2018 and April 2020. To be included, the hazard ratio (HR) [95% CI] for the time to first relapse after first‐line immunosuppression had to be available, calculable, or provided by the authors. Results We gathered data from 919 NMO patients (232 RTX‐, 294 MMF‐, and 393 AZA‐treated patients). The risk of first relapse after first‐line immunosuppression was 1.55 [1.04, 2.31] (p = 0.03) for MMF compared with RTX, 1.42 [0.87, 2.30] (p = 0.16) for AZA compared with RTX, and 0.94 [0.58, 1.54] (p = 0.08) for MMF compared with AZA. Interpretation The findings suggest that RTX is more efficient than MMF as a first‐line therapy. Even if the results of our meta‐analysis cannot conclude that RTX has a better efficacy in delaying the first relapse than AZA, the observed effect difference between both treatments combined with the results of previous studies using as outcome the annualized relapse rate may be in favor of RTX.
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Affiliation(s)
| | - Jonathan Ciron
- Department of Neurology, CRC-SEP, Hôpital Purpan, CHU de Toulouse, Toulouse, France
| | - Mikael Cohen
- CRCRSEP Nice, UR2CA URRIS, Université Nice Côte d'Azur, Neurologie, CHU Pasteur 2, Nice, France
| | - Ho-Jin Kim
- Department of Neurology, Research Institute & Hospital of National Cancer Center, Goyang, Korea
| | - Su-Hyun Kim
- Department of Neurology, Research Institute & Hospital of National Cancer Center, Goyang, Korea
| | - Jan-Patrik Stellmann
- Aix-Marseille University, CNRS, CRMBM, UMR 7339, APHM, Hôpital de la Timone, CEMEREM, Marseille, 13005, France
| | - Ingo Kleiter
- Department of Neurology, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany.,Marianne-Strauß-Klinik, Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke, Berg, Germany
| | - Morgan McCreary
- Department of Neurology, University of Texas Southwestern, Dallas, Texas, USA
| | | | - Romain Deschamps
- Department of Neurology, Hôpital Fondation Adolphe de Rothschild, Paris, France
| | - Bertrand Audoin
- Aix-Marseille Université, Service de Neurologie, Pôle de Neurosciences Cliniques, APHM, Hôpital de la Timone, Marseille, France
| | - Elisabeth Maillart
- Department of Neurology, Hôpital Pitié Salpêtrière, AP-HP, Paris, France.,National Referral Center of Rare Inflammatory Brain and Spinal Diseases (MIRCEM), Paris, France
| | - Caroline Papeix
- Department of Neurology, Hôpital Pitié Salpêtrière, AP-HP, Paris, France.,National Referral Center of Rare Inflammatory Brain and Spinal Diseases (MIRCEM), Paris, France
| | - Nicolas Collongues
- Biopathologie de la Myéline, Neuroprotection et Stratégies Thérapeutiques, U1119, Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France
| | | | - David Laplaud
- Université de Nantes, CHU Nantes, Inserm Centre de Recherche en Transplantation et Immunologie, UMR 1064, Nantes, F-44000, France
| | - Xavier Ayrignac
- Department of Neurology CHU Montpellier, INM, University of Montpellier, Inserm, Montpellier, France
| | | | - Aurélie Ruet
- University of Bordeaux, Inserm U1215 - Neurocentre Magendie, CHU de Bordeaux, Neurologie et Maladies inflammatoires du système nerveux central, Bordeaux, F-33000, France
| | - Sandra Vukusic
- Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
| | - Romain Marignier
- Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France.,Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuroinflammation, Centre de Référence des maladies Inflammatoires Rares du Cerveau et de la Moelle, U1028, CNRS, UMR 5292, Center for Research in Neuroscience of Lyon, Lyon 1 University, Lyon, France
| | - Luc Dauchet
- University of Lille, INSERM, CHU Lille, Institut Pasteur de Lille, U1167-RID-AGE-Facteurs de risque et déterminants moléculaires des maladies liées au vieillissement, Lille, F-59000, France
| | - Hélène Zephir
- Department of Neurology, CRCSEP Lille, CHU de Lille, University of Lille, Inserm U1172, Lille, France
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Liu C, Shi M, Zhu M, Chu F, Jin T, Zhu J. Comparisons of clinical phenotype, radiological and laboratory features, and therapy of neuromyelitis optica spectrum disorder by regions: update and challenges. Autoimmun Rev 2021; 21:102921. [PMID: 34384938 DOI: 10.1016/j.autrev.2021.102921] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 08/08/2021] [Indexed: 11/26/2022]
Abstract
Neuromyelitis optica spectrum disorder (NMOSD) is an inflammatory demyelinating disease of the central nervous system (CNS) associated with autoantibody (ab) to aquaporin-4 (AQP4). There is obvious variation between regions and countries in the epidemiology, clinical features and management in NMOSD. Based on published population-based observation and cohort studies, the different clinical pattern of NMOSD has been seen in several geographical regions and some of these patients with NMOSD-like features do not fully meet the current diagnostic criteria, which is needed to consider the value of recently revised diagnostic criteria. At present, all treatments applied in NMOSD have made great progress, however, these treatments failed in AQP4 ab negative and refractory patients. Therefore, it is necessary to turn into an innovative idea and to open a new era of NMOSD treatment to develop novel and diverse targets and effective therapeutic drugs in NMOSD and to conduct the trails in large clinical samples and case-control studies to confirm their therapeutic effects on NMOSD in the future, which still remain a challenge.
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Affiliation(s)
- Caiyun Liu
- Neuroscience Center, Department of Neurology, The First Hospital of Jilin University, Changchun, China.
| | - Mingchao Shi
- Neuroscience Center, Department of Neurology, The First Hospital of Jilin University, Changchun, China.
| | - Mingqin Zhu
- Neuroscience Center, Department of Neurology, The First Hospital of Jilin University, Changchun, China.
| | - Fengna Chu
- Neuroscience Center, Department of Neurology, The First Hospital of Jilin University, Changchun, China.
| | - Tao Jin
- Neuroscience Center, Department of Neurology, The First Hospital of Jilin University, Changchun, China.
| | - Jie Zhu
- Neuroscience Center, Department of Neurology, The First Hospital of Jilin University, Changchun, China; Department of Neurobiology, Care Sciences & Society, Division of Neurogeriatrcs, Karolinska Institutet, Karolinska University Hospital Solna, Stockholm, Sweden.
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Efficacy of mycophenolate mofetil in the treatment of neuromyelitis optica spectrum disorders: An update systematic review and meta -analysis. Mult Scler Relat Disord 2021; 55:103181. [PMID: 34365314 DOI: 10.1016/j.msard.2021.103181] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 07/14/2021] [Accepted: 07/29/2021] [Indexed: 01/11/2023]
Abstract
BACKGROUND Neuromyelitis optica spectrum disorders (NMOSD) is an autoimmune astrocyte disease that mainly affects the optic nerve and spinal cord resulting in blindness or paralysis. Mycophenolate mofetil (MMF) is one of the available immunotherapies with purported beneficial effects for patients with NMOSD. The present review aimed to conduct an update systematic review and meta-analysis for the efficacy of mycophenolate mofetil in the treatment of NMOSD and analyze main factors affecting the efficacy of mycophenolate mofetil. METHODS The following Medical Subject Heading (MeSH) and related entry terms are used to search English literature in PubMed, MEDLINE and CENTRAL databases, respectively. MeSH include: Neuromyelitis optic and Mycophenolic Acid; entry terms include: NMO Spectrum Disorder, NMO Spectrum Disorders, Neuromyelitis Optica (NMO) Spectrum Disorder, Neuromyelitis Optica Spectrum Disorders, Devic Neuromyelitis Optica, Neuromyelitis Optica, Devic, Devic's Disease, Devic Syndrome, Devic's Neuromyelitis Optica, Neuromyelitis Optica (NMO) Spectrum Disorders, Mycophenolate Mofetil, Mofetil, Mycophenolate, Mycophenolic Acid Morpholinoethyl Ester, Cellcept, Mycophenolate Sodium, Myfortic, Mycophenolate Mofetil Hydrochloride, Mofetil Hydrochloride, Mycophenolate, RS 61,443, RS-61,443, RS61443; (note: literature retrieval operators "AND" "OR" "NOT" are used to link MeSH with Entry Terms.) 30 studies were included in this systematic review and 14 studies were included in meta-analysis. The main efficacy indicators were the difference of the annualized relapse rate (ARR) between before and after mycophenolate mofetil treatments. RESULTS In 14 studies involving 930 patients (815 women, 115 men), the ARR were reduced by an average of -1.17 (95%CI, -1.28 to -1.07). CONCLUSION Our systematic review and update meta-analysis provide new evidences that mycophenolate mofetil can substantially reduce ARR ratio.
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Zhang J, Li Y, Zhou Y, Zhao Y, Xie H, Duan R, Yao Y, Gong Z, Teng J, Jia Y. Serum Homocysteine Level Is a Predictor of Relapse and Prognosis in Patients With First-Attack Neuromyelitis Optica Spectrum Disorders. Front Neurol 2021; 12:667651. [PMID: 34122309 PMCID: PMC8187771 DOI: 10.3389/fneur.2021.667651] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 04/26/2021] [Indexed: 12/23/2022] Open
Abstract
Background: Many patients with neuromyelitis optica spectrum disorders (NMOSD) experience the adverse consequences of relapse and disability aggravation. Thus, it is necessary to identify sensitive and reliable biomarkers for early prognosis. This study investigated whether serum homocysteine (Hcy) level was associated with the risk of relapse or poor prognosis in first-attack NMOSD patients. Methods: We enrolled 161 first-attack NMOSD patients in this retrospective study. We reviewed their medical records and evaluated their initial Expanded Disability Status Scale (EDSS). Clinical outcomes were measured by the final EDSS and the relapse rate. The association between Hcy levels and EDSS score at last follow-up was analyzed by binary logistic regression. The association between Hcy levels and relapse rate was assessed by Cox regression analysis. Receiver operating characteristic (ROC) curve analysis was used to predict the target value of Hcy reduction. Results: Compared with the high Hcy group, the final EDSS score in the low Hcy group was significantly lower (median: 0.5 vs. 2.5, P < 0.001). The relapse rate differed significantly between these groups (30.6 vs. 50.0%, P = 0.023). Multivariate analysis showed that the initial EDSS score (odds ratio [OR] 3.03, 95% confidence interval [CI] 2.07–4.45, P < 0.001) and serum Hcy level (OR 1.13, 95%CI 1.04–1.22, P = 0.002) were significantly associated with poor prognosis in NMOSD patients. Additionally, multivariate analysis showed that serum Hcy level (hazard ratio 1.06, 95%CI 1.04–1.09, P < 0.001) was an independent predictor of the risk for relapse in NMOSD. The 12-month relapse rate of the high Hcy group was 34.8%, and 50% of high Hcy patients relapsed within 35 months after the first onset. A serum Hcy level exceeding 14.525 μmol/L indicated a high risk of relapse, with a sensitivity of 43.7%, specificity of 90.0%, and area under the ROC curve of 0.674 (95%CI 0.59–0.76, P < 0.001). Conclusion: Serum Hcy level is an independent predictor of relapse and poor prognosis in first-attack NMOSD patients. Early monitoring and reduction of serum Hcy levels may be of great significance in the prevention of disease relapse and severe disability.
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Affiliation(s)
- Jinwei Zhang
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yanfei Li
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yongyan Zhou
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yi Zhao
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Haojie Xie
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ranran Duan
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yaobing Yao
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhe Gong
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Junfang Teng
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yanjie Jia
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Velasco M, Zarco LA, Agudelo-Arrieta M, Torres-Camacho I, Garcia-Cifuentes E, Muñoz O. Effectiveness of treatments in Neuromyelitis optica to modify the course of disease in adult patients. Systematic review of literature. Mult Scler Relat Disord 2021; 50:102869. [PMID: 33711580 DOI: 10.1016/j.msard.2021.102869] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 02/13/2021] [Accepted: 02/22/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Neuromyelitis Optica spectrum disorder (NMOSD) is an inflammatory disease, which manifests mostly as recurrent episodes of optic neuritis or myelitis that cause important disability. Early diagnosis and prompt initiation of immunosuppressive therapy are crucial in reducing relapses, disability, and mortality. Even though, there are few prospective randomized controlled trials, several drugs have proved to be both effective and safe. Azathioprine and Rituximab represent the standard of care and are used as first-line treatment agents worldwide. However, recent studies have unveiled new therapies, such as monoclonal antibodies. To make treatment recommendations and management guidelines, it is imperative to define an appropriate standard of care. METHODS A systematic literature review was performed in MEDLINE, EMBASE, and LILACS databases using the following terms: "(NMO OR Devic OR Neuromyelitis Optica) AND (Azathioprine OR Prednisone OR Rituximab OR Tocilizumab OR Bortezomib OR Inebilizumab OR Eculizumab OR Satralizumab)" including both, randomized clinical trials and observational studies published between January 2006 and January 2021. The inclusion criteria comprised patients aged 18 or older, NMOSD diagnosis following the Wingerchuck criteria, two or more therapies been compared, and the evaluation of both efficacy and safety outcomes. All studies comparing treatment only with placebo were excluded. Quality was assessed according with the design of the study, and results were synthesized through comparative tables for each outcome evaluated, differentiating the results of randomized and non-randomized studies. RESULTS Thirteen studies with 1447 patients were included. Twelve studies evaluated the expanded disability status scale (EDSS) before and after treatment; in five of seven evaluating rituximab, it outperformed its comparators in improving the disability degree. Eleven studies assessed the annual relapse rate (ARR). Again, in six of seven evaluating rituximab, it was superior to other therapies. Time to relapse (TTR) was reported in five studies. The three studies that included Rituximab revealed a longer time to relapse in this arm of treatment. Finding were consistent in randomized and non-randomized studies. The new molecules Satralizumab, Eculizumab and Tocilizumab were evaluated in one study each, proving to be highly effective and safe. The safety profile analysis showed a higher number of adverse events for Azathioprine. DISCUSSION This systematic review demonstrates a superiority tendency of Rituximab upon the other treatments strengthening the available evidence about NMOSD management. Superiority in EDSS outcomes, annual relapse rate, time to first relapse and relapses during treatment time was evidenced in the Rituximab group compared to other medications, with lower rates of adverse events. New molecules Tocilizumab, Eculizumab and Satralizumab also showed superiority in the evaluated results, especially in the relapses during treatment time outcome, although with subtle differences in EDSS and ARR outcomes. CONCLUSION Our results suggest that monoclonal antibodies are highly effective and safe for the treatment of NMOSD; Rituximab showed better performance on multiple outcomes and has more evidence available. New molecules: Eculizumab, Tocilizumab, Satralizumab are good options for treatment. Drugs like Azathioprine and Mycophenolate are effective, but with a worse risk-benefit ratio, therefore, they are useful alternatives in places that do not have access to monoclonal antibodies.
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Affiliation(s)
- Mario Velasco
- Pontificia Universidad Javeriana, Bogotá, Colombia; Department of Neurosciences, Hospital Universitario San Ignacio, Bogotá, Colombia.
| | - Luis Alfonso Zarco
- Pontificia Universidad Javeriana, Bogotá, Colombia; Department of Neurosciences, Hospital Universitario San Ignacio, Bogotá, Colombia; Professor of Neurology and head of Neuroscience department
| | - Mariana Agudelo-Arrieta
- Pontificia Universidad Javeriana, Bogotá, Colombia; Department of Neurosciences, Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Isabel Torres-Camacho
- Pontificia Universidad Javeriana, Bogotá, Colombia; Department of Neurosciences, Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Elkin Garcia-Cifuentes
- Pontificia Universidad Javeriana, Bogotá, Colombia; Department of Neurosciences, Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Oscar Muñoz
- Pontificia Universidad Javeriana, Bogotá, Colombia; Department of Internal Medicine, Hospital Universitario San Ignacio, Bogotá, Colombia; Associate professor
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Takai Y, Kuroda H, Misu T, Akaishi T, Nakashima I, Takahashi T, Nishiyama S, Fujihara K, Aoki M. Optimal management of neuromyelitis optica spectrum disorder with aquaporin-4 antibody by oral prednisolone maintenance therapy. Mult Scler Relat Disord 2021; 49:102750. [PMID: 33524925 DOI: 10.1016/j.msard.2021.102750] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 12/28/2020] [Accepted: 01/08/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Neuromyelitis optica spectrum disorder (NMOSD) is a relapsing neuroinflammatory disease associated with aquaporin-4 antibody. Since disabilities in patients with NMOSD accumulate with attacks, relapse prevention is crucially important for improving long-term outcomes. Corticosteroids are inexpensive and promising drugs for relapse prevention in NMOSD, but few studies have analysed the efficacy of corticosteroids in NMOSD, especially regarding the appropriate dosing and tapering regimens. METHODS A single-center, retrospective analysis of corticosteroid therapy in aquaporin-4 antibody-positive NMOSD patients fulfilling the 2015 international consensus diagnostic criteria was conducted. RESULTS Medical records of a total of 89 Japanese patients with aquaporin-4 antibody-positive NMOSD seen at Department of Neurology, Tohoku University Hospital (2000~2016) were reviewed. At the last follow-up, 66% of the patients were treated with prednisolone (PSL) monotherapy, and the percentage of those receiving PSL monotherapy or a combination of PSL and other immunosuppressants increased from 17.5% in 2000 to 94.1% in 2016. On the other hand, annualised relapse rate (ARR) decreased from 0.78 (13 attacks in 200 person-months) in 2000 to 0.07 (5 attacks in 819 person-months) in 2016. Under PSL treatment, the mean ARR significantly decreased, and disabilities stabilized (PSL treatment vs no-medication; ARR: 0.21 vs 0.98, P < 0.01, Expanded Disability Status Scale score change: +0.02 vs +0.89, P < 0.01, observation periods: 60.1 vs 68.2 months, P=0.26). Using Kaplan-Meier curves, the 10-year relapse-free rate was 46.5% with PSL monotherapy and 7.1% with no medication (hazard ratio: 0.069, 95% confidence interval [CI] 0.024-0.199, P < 0.01). Rapid tapering of PSL (10 mg or less in one year and/or 5 mg or less in two years after clinical attacks) was associated with frequent relapses compared to gradual tapering (more than 10 mg in one year and more than 5 mg in two years after clinical attacks) (rapid vs gradual, 36.7% vs 17.7%, odds ratio 2.69, 95% CI 1.12-6.44, P = 0.02). However, even with PSL of 5 mg/day or less, the relapse rate was low after two years of acute treatment (before vs after, 53.8% vs 13.6%, odds ratio 0.12, 95% CI 0.03-0.50, P < 0.01). Nine patients needed additional immunosuppressants due to insufficient relapse prevention by PSL monotherapy. PSL monotherapy was generally well tolerated, but seven patients had severe adverse events, mainly bone fractures (5 with bone fracture, 1 with femoral capital necrosis and 1 with cerebral infarction). CONCLUSION Our study suggests that PSL monotherapy is effective to prevent relapses in about half of patients with aquaporin-4 antibody-positive NMOSD if the doses are gradually reduced. Although it is important to have a treatment strategy tailored to each patient, this study provides evidence that PSL monotherapy can be an option for relapse prevention in some patients with NMOSD.
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Affiliation(s)
- Yoshiki Takai
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan..
| | - Hiroshi Kuroda
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan.; Department of Neurology, South Miyagi Medical Center, Shibata, Japan
| | - Tatsuro Misu
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Tetsuya Akaishi
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan.; Department of Education and Support for Regional Medicine, Tohoku University Hospital, Sendai, Japan
| | - Ichiro Nakashima
- Department of Neurology, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Toshiyuki Takahashi
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan.; Department of Neurology, National Hospital Organization Yonezawa National Hospital, Yonezawa, Japan
| | - Shuhei Nishiyama
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kazuo Fujihara
- Department of Multiple Sclerosis Therapeutics, Fukushima Medical University School of Medicine, Fukushima, Japan; Multiple Sclerosis & Neuromyelitis Center, Southern TOHOKU Research Institute for Neuroscience, Koriyama, Japan
| | - Masashi Aoki
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan
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Qin C, Tao R, Zhang SQ, Chen B, Chen M, Yu HH, Chu YH, Shang K, Wu LJ, Bu BT, Tian DS. Predictive Factors of Resistance to High-Dose Steroids Therapy in Acute Attacks of Neuromyelitis Optica Spectrum Disorder. Front Neurol 2020; 11:585471. [PMID: 33281722 PMCID: PMC7688779 DOI: 10.3389/fneur.2020.585471] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 10/12/2020] [Indexed: 12/13/2022] Open
Abstract
High-dose steroids, the first-line therapy for acute attacks in neuromyelitis optica spectrum disorder (NMOSD), were ineffective in a proportion of NMOSD attacks. This study aimed to explore possible predictors of high-dose steroid resistance. Demographics and disease characteristics of acute attacks were compared between those who responded to high-dose intravenous methylprednisolone (IVMP) and those resistant to IVMP. In total, 197 attacks in 160 patients were identified in our NMOSD registry. Compared with responders, attacks resistant to high-dose steroids tended to have a higher proportion of previous history of immunosuppressive use (25.5 vs. 15.5%, p = 0.080). Significantly higher levels of proteins in the cerebrospinal fluid (CSF) were found in non-responders than in responders [485.5 (388–656) vs. 387 (291.5–532) mg/L, p = 0.006]. More active lesions were found in the brain stem of non-responders (8 attacks in 55, 14.5%), especially in the pons (7.3%) and medulla (14.5%), as opposed to responders (7 patients in 142, 4.9%). Multivariable logistic regression showed that resistance to high-dose steroid treatment was associated with previous immunosuppressant use [odds ratio (OR), 2.31; 95% confidence interval (CI) 1.002–5.34, p = 0.049], CSF protein level above 450 mg/L (OR 3.42, 95% CI 1.72–6.82, p < 0.001), and active lesions in the brainstem (OR 3.80, 95% CI 1.17–12.32, p = 0.026). In conclusion, NMOSD patients with previous use of immunosuppressants, higher levels of CSF protein, and active lesions in the brainstem are more likely to respond poorly to high-dose IVMP alone during an acute attack.
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Affiliation(s)
- Chuan Qin
- Department of Neurology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Ran Tao
- Department of Neurology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Shuo-Qi Zhang
- Department of Radiology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Bo Chen
- Department of Neurology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Man Chen
- Department of Neurology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Hai-Han Yu
- Department of Neurology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Yun-Hui Chu
- Department of Neurology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Ke Shang
- Department of Neurology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Long-Jun Wu
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | - Bi-Tao Bu
- Department of Neurology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Dai-Shi Tian
- Department of Neurology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
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Han M, Nong L, Liu Z, Chen Y, Chen Y, Meng H, Qin Y, Wang Z, Jin M. Safety and efficacy of mycophenolate mofetil in treating neuromyelitis optica spectrum disorders: a protocol for systematic review and meta-analysis. BMJ Open 2020; 10:e040371. [PMID: 33257483 PMCID: PMC7705552 DOI: 10.1136/bmjopen-2020-040371] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Neuromyelitis optica spectrum disorders (NMOSD) is an inflammatory and heterogeneous astrocyte disorder of the central nervous system with the characteristic of higher incidence in women and Asian people. Most patients with NMOSD have a course of recurrence and remission that is prone to cause paralysis and blindness. Several studies have confirmed the efficacy and promising prospect of mycophenolate mofetil (MMF) in the treatment of NMOSD. Yet its therapeutic effect and safety are controversial. Although there has been two published literature that is relevant to the topic of this study, both of them have certain defects, and they can only provide answers about the efficacy or safety of MMF in the treatment of NMOSD from partial perspectives or conclusions. This research aims to perform a direct and comprehensive systematic review and meta-analysis to evaluate MMF's effectiveness and safety in treating NMOSD. METHODS AND ANALYSIS This systematic review will cover all comparative researches, from randomised controlled trials to cohort studies, and case-control study. A relevant literature search will be conducted in PubMed, Web of Science, EMBASE, the Cochrane Library, China National Knowledge Infrastructure, Wanfang Database, China Science and Technology Journal Database and Chinese Biomedical Literature Database from their inception to 31 June 2020. We will also search registers of clinical trials, potential grey literature and abstracts from conferences. There are no limits on language and publication status. The reporting quality and risk of bias will be assessed by two researchers independently. Expanded Disability Status Scales and annualised relapse rate will be evaluated as the primary outcome. The secondary outcomes will consist of the frequency and severity of adverse events, best-corrected visual acuity, relapse-free rate and time to the next attack. A meta-analysis will be performed using RevMan V.5.3 software provided by the Cochrane Collaboration and Stata V.12.0. ETHICS AND DISSEMINATION Because the data used for this systematic review will be exclusively extracted from published studies, ethical approval and informed consent of patients will not be required. The systematic review will be published in a peer-reviewed journal, presented at conferences and will be shared on social media platforms. PROSPERO REGISTRATION NUMBER CRD42020164179.
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Affiliation(s)
- Mengyu Han
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
- Department of Ophthalmology, China-Japan Friendship Hospital, Beijing, China
| | - Luqi Nong
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
- Department of Ophthalmology, China-Japan Friendship Hospital, Beijing, China
| | - Ziqiang Liu
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
- Department of Ophthalmology, China-Japan Friendship Hospital, Beijing, China
| | - You Chen
- Department of Ophthalmology, China-Japan Friendship Hospital, Beijing, China
| | - Yang Chen
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Huan Meng
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
- Department of Ophthalmology, China-Japan Friendship Hospital, Beijing, China
| | - Yali Qin
- Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
| | - Zhijun Wang
- Department of Ophthalmology, China-Japan Friendship Hospital, Beijing, China
| | - Ming Jin
- Department of Ophthalmology, China-Japan Friendship Hospital, Beijing, China
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Cai LJ, Zhang Q, Zhang Y, Chen HX, Shi ZY, Du Q, Zhou HY. Clinical characteristics of very late-onset neuromyelitis optica spectrum disorder. Mult Scler Relat Disord 2020; 46:102515. [PMID: 33032051 DOI: 10.1016/j.msard.2020.102515] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 09/11/2020] [Accepted: 09/15/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND The typical age at onset of neuromyelitis optica spectrum disorder (NMOSD) is between 30 and 40 years. A growing awareness about the disease and advances in diagnostic techniques have led to an increase in the number of patients being diagnosed with very late-onset (VLO) NMOSD. This study compared the clinical characteristics, treatments, and prognoses between patients with VLO-NMOSD or late-onset (LO) NMOSD. METHODS Patients in our study were assigned to two groups based on age at onset of the disease: LO-NMOSD (50-70 years old at onset) and VLO-NMOSD (> 70 years old at onset). We compared clinical characteristics, magnetic resonance imaging of lesions, prognosis, and treatments between the two groups. RESULTS We collected data from 12 VLO-NMOSD patients with a median age at onset of 74.0 years (interquartile range, 72.6-75.9 years) and 104 LO-NMOSD patients with a median age at onset of 56.0 years (55.8-57.9 years). There were a high proportion of female patients in both the VLO-NMOSD group (9, 75.0%) and the LO-NMOSD group (91, 87.5%). Our study indicated that VLO-NMOSD patients had significantly higher expanded disability status scale (EDSS) scores (8.5 vs 4.0, p = 0.01), higher motor disability rates (41.7% vs 9.6%, p = 0.002), and higher mortality rates (25.0 vs 4.8%, p = 0.044) at last follow-up. However, patients with VLO-NMOSD had lower rates of immunosuppressant usage (50.0% vs 76.9%, p = 0.044). Age at onset was positively correlated with EDSS score at remission (r = 0.49, p < 0.001). CONCLUSION VLO-NMOSD was associated with higher EDSS score at remission, higher rates of mortality and motor disability, but lower rates of immunosuppressive treatment usage than LO-NMOSD. Future studies are needed to understand the effects of NMOSD on older patients, and to seek suitable treatment to improve their prognosis.
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Affiliation(s)
- L J Cai
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Q Zhang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Y Zhang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - H X Chen
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Z Y Shi
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Q Du
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - H Y Zhou
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
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Luo D, Wei R, Tian X, Chen C, Ma L, Li M, Dong X, Zhang E, Zhou Y, Cui Y. Efficacy and safety of azathioprine for neuromyelitis optica spectrum disorders: A meta-analysis of real-world studies. Mult Scler Relat Disord 2020; 46:102484. [PMID: 32932167 DOI: 10.1016/j.msard.2020.102484] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 08/31/2020] [Accepted: 09/02/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE This study aimed to perform a meta-analysis of the efficacy and safety of azathioprine (AZA) for neuromyelitis optica spectrum disorders (NMOSD), considering the potential predictive factors related to patient response to AZA in this disease. METHODS We performed a systematic online query in PubMed, EMBASE, The Cochrane Library, ClinicalTrials.gov, China National Knowledge Infrastructure, WANFANG DATA, and CQVIP DATA. The available studies on the use of AZA in NMOSD patients were included. RESULTS We analyzed a total of 21 studies including 1016 patients. Results demonstrated that AZA significantly decreased annual relapse rate (ARR) by 1.164 (95% confidence intervals (CI), -1.396 to -0.932; p < 0.001). Subgroup analysis showed that AZA significantly decreased ARR in both low-dose group (effect size (ES): -1.545) and moderate-dose group (ES: -2.026). AZA therapy also resulted in a significant reduction of 1.117 (95% CI: -1.668 to -0.566; p < 0.001) in expanded disability status scale (EDSS) score. AZA did not affect EDSS score in the low-dose subgroup (ES: -0.535; p = 0.209) or the moderate-dose subgroup (ES: -0.709; p = 0.064). During AZA therapy, 47% of patients did not experience any relapses (95% CI, 39% to 54%). In addition, 13% of patients developed leukopenia, 11% had elevated liver enzyme levels, 8% experienced nausea or vomiting, 5% developed pancytopenia and 6% died during follow-up. CONCLUSION AZA is effective in reducing relapse and improving patients' neurological function. However, liver function monitoring and routine blood monitoring remain necessary. Within the safe upper limit, a higher dose of AZA may be associated with a better efficacy for NMOSD.
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Affiliation(s)
- Daohuang Luo
- Department of Pharmacy, Peking University First Hospital, Beijing, China; College of Pharmacy, Peking University, Beijing, China
| | - Ran Wei
- Department of Pharmacy, Peking University First Hospital, Beijing, China
| | - Xin Tian
- Department of Pharmacy, Peking University First Hospital, Beijing, China; College of Pharmacy, Peking University, Beijing, China
| | - Chaoyang Chen
- Department of Pharmacy, Peking University First Hospital, Beijing, China; College of Pharmacy, Peking University, Beijing, China
| | - Lingyun Ma
- Department of Pharmacy, Peking University First Hospital, Beijing, China
| | - Min Li
- Department of Pharmacy, Peking University First Hospital, Beijing, China; College of Pharmacy, Peking University, Beijing, China
| | - Xiu Dong
- Department of Pharmacy, Peking University First Hospital, Beijing, China; College of Pharmacy, Peking University, Beijing, China
| | - Enyao Zhang
- Department of Pharmacy, Peking University First Hospital, Beijing, China; College of Pharmacy, Peking University, Beijing, China
| | - Ying Zhou
- Department of Pharmacy, Peking University First Hospital, Beijing, China; College of Pharmacy, Peking University, Beijing, China.
| | - Yimin Cui
- Department of Pharmacy, Peking University First Hospital, Beijing, China; College of Pharmacy, Peking University, Beijing, China.
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