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Wylezinski LS, Sesler CL, Shaginurova GI, Grigorenko EV, Wohlgemuth JG, Cockerill FR, Racke MK, Spurlock CF. Machine Learning Analysis Using RNA Sequencing to Distinguish Neuromyelitis Optica from Multiple Sclerosis and Identify Therapeutic Candidates. J Mol Diagn 2024; 26:520-529. [PMID: 38522839 PMCID: PMC11163981 DOI: 10.1016/j.jmoldx.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 01/19/2024] [Accepted: 03/01/2024] [Indexed: 03/26/2024] Open
Abstract
This study aims to identify RNA biomarkers distinguishing neuromyelitis optica (NMO) from relapsing-remitting multiple sclerosis (RRMS) and explore potential therapeutic applications leveraging machine learning (ML). An ensemble approach was developed using differential gene expression analysis and competitive ML methods, interrogating total RNA-sequencing data sets from peripheral whole blood of treatment-naïve patients with RRMS and NMO and healthy individuals. Pathway analysis of candidate biomarkers informed the biological context of disease, transcription factor activity, and small-molecule therapeutic potential. ML models differentiated between patients with NMO and RRMS, with the performance of certain models exceeding 90% accuracy. RNA biomarkers driving model performance were associated with ribosomal dysfunction and viral infection. Regulatory networks of kinases and transcription factors identified biological associations and identified potential therapeutic targets. Small-molecule candidates capable of reversing perturbed gene expression were uncovered. Mitoxantrone and vorinostat-two identified small molecules with previously reported use in patients with NMO and experimental autoimmune encephalomyelitis-reinforced discovered expression signatures and highlighted the potential to identify new therapeutic candidates. Putative RNA biomarkers were identified that accurately distinguish NMO from RRMS and healthy individuals. The application of multivariate approaches in analysis of RNA-sequencing data further enhances the discovery of unique RNA biomarkers, accelerating the development of new methods for disease detection, monitoring, and therapeutics. Integrating biological understanding further enhances detection of disease-specific signatures and possible therapeutic targets.
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Affiliation(s)
- Lukasz S Wylezinski
- Decode Health, Inc., Nashville, Tennessee; Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
| | | | | | | | - Jay G Wohlgemuth
- Quest Diagnostics, Secaucus, New Jersey; Trusted Health Advisors, San Juan Capistrano, California
| | - Franklin R Cockerill
- Decode Health, Inc., Nashville, Tennessee; Trusted Health Advisors, San Juan Capistrano, California; Department of Medicine, Rush University Medical Center, Chicago, Illinois
| | | | - Charles F Spurlock
- Decode Health, Inc., Nashville, Tennessee; Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee; Wagner School of Public Service, New York University, New York, New York.
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Bergeron E, Bouffard MA. Evidence-based management of optic neuritis. Curr Opin Ophthalmol 2024; 35:73-82. [PMID: 37846574 DOI: 10.1097/icu.0000000000001007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2023]
Abstract
PURPOSE OF REVIEW Optic neuritis can result from several distinct causes, including multiple sclerosis (MS), neuromyelitis optica spectrum disorder (NMOSD), and myelin oligodendrocyte glycoprotein antibody disease (MOGAD), when not idiopathic. This review discusses evidence-based treatment approaches contingent upon each specific cause of optic neuritis. RECENT FINDINGS Current evidence highlights the need for prompt plasmapheresis as adjunct to intravenous methylprednisolone (IVMP) in patients with NMOSD-associated optic neuritis. Recent advances have included a proliferation of novel disease modifying therapies (DMTs) for long-term management of NMOSD and an understanding of how existing therapeutic options can be leveraged to optimally treat MOGAD. SUMMARY In acute idiopathic or MS-associated optic neuritis, IVMP hastens visual recovery, though it does not substantially affect final visual outcomes. IVMP and adjunctive plasmapheresis are beneficial in the treatment of NMOSD-associated optic neuritis, with a shorter time-to-treatment associated with a higher likelihood of recovery. The natural history of untreated MOGAD-associated optic neuritis is unclear but treatment with IVMP is near-universal given phenotypic similarities with NMOSD. Long-term immunosuppressive therapy is warranted in patients with NMOSD as well as in patients with MOGAD with poor visual recovery or recurrent attacks.
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Affiliation(s)
- Emilie Bergeron
- Division of Neuro-Ophthalmology, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
- Département d'ophtalmologie et d'oto-rhino-laryngologie - chirurgie cervico-faciale, Faculté de médecine, Centre Universitaire d'Ophtalmologie, Hôpital du Saint-Sacrement, CHU de Québec-Université Laval, Quebec UO-Recherche-Clinique, Hôpital du Saint-Sacrement, Centre de recherche du CHU de Québec City, Québec City, Quebec, Canada
| | - Marc A Bouffard
- Division of Neuro-Ophthalmology, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
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Chaumont H, Bérard N, Karam JP, Lobjois Q, Tressieres B, Signate A, Lannuzel A, Cabre P. Mitoxantrone in NMO Spectrum Disorder in a Large Multicenter Cohort in French Caribbean. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2024; 11:e200175. [PMID: 37949668 PMCID: PMC10691227 DOI: 10.1212/nxi.0000000000200175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 08/30/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND AND OBJECTIVES Preventing relapses in neuromyelitis Optica spectrum disorder (NMOSD) is a primary goal. New effective molecules are often expensive and not readily available in regions with fragile health systems. Assessing the efficacy and safety of less costly therapeutic alternatives is necessary. We aim to evaluate the efficacy and safety of mitoxantrone (MiTX) in NMOSD. METHODS This is an observational, multicenter, open study of 86 NMOSD-treated patients with prospective follow-up over 30 years. The first endpoint was the first relapse at the 96-week follow-up. The secondary endpoints were to evaluate the median delay to relapse, the annualized relapse rate (ARR), and the Expanded Disability Status Scale (EDSS) at 96 weeks of follow-up and to assess risk factors of relapse and the occurrence of severe adverse effects. RESULTS At 96-week follow-up, 71% of our patients were relapse-free, and it was 87% when patients were treated with MiTX from the first attack. The ARR dropped from 0.85 (±0.55) to 0.32 (±0.63) (p < 0.001) and EDSS from 4.9 (±2.4) to 4.2 (±2.6) (p < 0.001). AQP4-IgG seropositivity (hazard ratio [HR] 12.3, 95% CI 1.64-91.6, p = 0.015), a delay between the first attack and MiTX ≥24 months (HR 2.76, 95% CI 1.23-6.17, p = 0.014), and a pretreatment ARR ≥1 (HR 2.38, 95% CI 1.05-5.39, p = 0.037) were predictors of relapse. During the entire follow-up, severe secondary adverse events occurred in 3 patients (3.5%). DISCUSSION MiTX is an effective and safe treatment for most of our patients, drastically less expensive than new molecules, and could be allowed in NMOSD Afro-descendant patients in geographical areas where access to care is difficult.
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Affiliation(s)
- Hugo Chaumont
- From the Department of Neurology (H.C., N.B., J.-P.K., A.L.), University Hospital of Guadeloupe; Faculté de Médecine de l'Université des Antilles (H.C., N.B., J.-P.K., A.L., P.C.), French West Indies, Pointe-à-Pitre; Faculté de Médecine de Sorbonne Université, Institut National de la Santé et de la Recherche Médicale, U 1127, CNRS, Unité Mixte de Recherche (UMR) 7225 (H.C., A.L.), Institut du Cerveau, ICM, Paris; Department of Neurology (Q.L., A.S., P.C.), Pierre Zobda-Quitman University Hospital; and Centre d'investigation Clinique Antilles Guyane, Inserm CIC 1424 (B.T., A.L.), University Hospital of Guadeloupe, Pointe-à-Pitre/Abymes, French West Indies, France.
| | - Nicolas Bérard
- From the Department of Neurology (H.C., N.B., J.-P.K., A.L.), University Hospital of Guadeloupe; Faculté de Médecine de l'Université des Antilles (H.C., N.B., J.-P.K., A.L., P.C.), French West Indies, Pointe-à-Pitre; Faculté de Médecine de Sorbonne Université, Institut National de la Santé et de la Recherche Médicale, U 1127, CNRS, Unité Mixte de Recherche (UMR) 7225 (H.C., A.L.), Institut du Cerveau, ICM, Paris; Department of Neurology (Q.L., A.S., P.C.), Pierre Zobda-Quitman University Hospital; and Centre d'investigation Clinique Antilles Guyane, Inserm CIC 1424 (B.T., A.L.), University Hospital of Guadeloupe, Pointe-à-Pitre/Abymes, French West Indies, France
| | - Jean-Pierre Karam
- From the Department of Neurology (H.C., N.B., J.-P.K., A.L.), University Hospital of Guadeloupe; Faculté de Médecine de l'Université des Antilles (H.C., N.B., J.-P.K., A.L., P.C.), French West Indies, Pointe-à-Pitre; Faculté de Médecine de Sorbonne Université, Institut National de la Santé et de la Recherche Médicale, U 1127, CNRS, Unité Mixte de Recherche (UMR) 7225 (H.C., A.L.), Institut du Cerveau, ICM, Paris; Department of Neurology (Q.L., A.S., P.C.), Pierre Zobda-Quitman University Hospital; and Centre d'investigation Clinique Antilles Guyane, Inserm CIC 1424 (B.T., A.L.), University Hospital of Guadeloupe, Pointe-à-Pitre/Abymes, French West Indies, France
| | - Quentin Lobjois
- From the Department of Neurology (H.C., N.B., J.-P.K., A.L.), University Hospital of Guadeloupe; Faculté de Médecine de l'Université des Antilles (H.C., N.B., J.-P.K., A.L., P.C.), French West Indies, Pointe-à-Pitre; Faculté de Médecine de Sorbonne Université, Institut National de la Santé et de la Recherche Médicale, U 1127, CNRS, Unité Mixte de Recherche (UMR) 7225 (H.C., A.L.), Institut du Cerveau, ICM, Paris; Department of Neurology (Q.L., A.S., P.C.), Pierre Zobda-Quitman University Hospital; and Centre d'investigation Clinique Antilles Guyane, Inserm CIC 1424 (B.T., A.L.), University Hospital of Guadeloupe, Pointe-à-Pitre/Abymes, French West Indies, France
| | - Benoit Tressieres
- From the Department of Neurology (H.C., N.B., J.-P.K., A.L.), University Hospital of Guadeloupe; Faculté de Médecine de l'Université des Antilles (H.C., N.B., J.-P.K., A.L., P.C.), French West Indies, Pointe-à-Pitre; Faculté de Médecine de Sorbonne Université, Institut National de la Santé et de la Recherche Médicale, U 1127, CNRS, Unité Mixte de Recherche (UMR) 7225 (H.C., A.L.), Institut du Cerveau, ICM, Paris; Department of Neurology (Q.L., A.S., P.C.), Pierre Zobda-Quitman University Hospital; and Centre d'investigation Clinique Antilles Guyane, Inserm CIC 1424 (B.T., A.L.), University Hospital of Guadeloupe, Pointe-à-Pitre/Abymes, French West Indies, France
| | - Aissatou Signate
- From the Department of Neurology (H.C., N.B., J.-P.K., A.L.), University Hospital of Guadeloupe; Faculté de Médecine de l'Université des Antilles (H.C., N.B., J.-P.K., A.L., P.C.), French West Indies, Pointe-à-Pitre; Faculté de Médecine de Sorbonne Université, Institut National de la Santé et de la Recherche Médicale, U 1127, CNRS, Unité Mixte de Recherche (UMR) 7225 (H.C., A.L.), Institut du Cerveau, ICM, Paris; Department of Neurology (Q.L., A.S., P.C.), Pierre Zobda-Quitman University Hospital; and Centre d'investigation Clinique Antilles Guyane, Inserm CIC 1424 (B.T., A.L.), University Hospital of Guadeloupe, Pointe-à-Pitre/Abymes, French West Indies, France
| | - Annie Lannuzel
- From the Department of Neurology (H.C., N.B., J.-P.K., A.L.), University Hospital of Guadeloupe; Faculté de Médecine de l'Université des Antilles (H.C., N.B., J.-P.K., A.L., P.C.), French West Indies, Pointe-à-Pitre; Faculté de Médecine de Sorbonne Université, Institut National de la Santé et de la Recherche Médicale, U 1127, CNRS, Unité Mixte de Recherche (UMR) 7225 (H.C., A.L.), Institut du Cerveau, ICM, Paris; Department of Neurology (Q.L., A.S., P.C.), Pierre Zobda-Quitman University Hospital; and Centre d'investigation Clinique Antilles Guyane, Inserm CIC 1424 (B.T., A.L.), University Hospital of Guadeloupe, Pointe-à-Pitre/Abymes, French West Indies, France
| | - Philippe Cabre
- From the Department of Neurology (H.C., N.B., J.-P.K., A.L.), University Hospital of Guadeloupe; Faculté de Médecine de l'Université des Antilles (H.C., N.B., J.-P.K., A.L., P.C.), French West Indies, Pointe-à-Pitre; Faculté de Médecine de Sorbonne Université, Institut National de la Santé et de la Recherche Médicale, U 1127, CNRS, Unité Mixte de Recherche (UMR) 7225 (H.C., A.L.), Institut du Cerveau, ICM, Paris; Department of Neurology (Q.L., A.S., P.C.), Pierre Zobda-Quitman University Hospital; and Centre d'investigation Clinique Antilles Guyane, Inserm CIC 1424 (B.T., A.L.), University Hospital of Guadeloupe, Pointe-à-Pitre/Abymes, French West Indies, France
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Yong HYF, Burton JM. A Clinical Approach to Existing and Emerging Therapeutics in Neuromyelitis Optica Spectrum Disorder. Curr Neurol Neurosci Rep 2023; 23:489-506. [PMID: 37540387 DOI: 10.1007/s11910-023-01287-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2023] [Indexed: 08/05/2023]
Abstract
PURPOSE OF REVIEW Neuromyelitis optica spectrum disorder (NMOSD) is a rare but highly disabling disease of the central nervous system. Unlike multiple sclerosis, disability in NMOSD occurs secondary to relapses that, not uncommonly, lead to blindness, paralysis, and death. Recently, newer, targeted immunotherapies have been trialed and are now in the treatment arsenal. We have endeavoured to evaluate the current state of NMOSD therapeutics. RECENT FINDINGS This review provides a pragmatic evaluation of recent clinical trials and post-marketing data for rituximab, inebilizumab, satralizumab, eculizumab, and ravalizumab, contrasted to older agents. We also review contemporary issues such as treatment in the context of SARS-CoV2 infection and pregnancy. There has been a dramatic shift in NMOSD morbidity and mortality with earlier and improved disease recognition, diagnostic accuracy, and the advent of more effective, targeted therapies. Choosing a maintenance therapy remains nuanced depending on patient factors and accessibility. With over 100 putative agents in trials, disease-free survival is now a realistic goal for NMOSD patients.
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Affiliation(s)
- Heather Y F Yong
- Division of Neurology, Department of Clinical Neurosciences, University of Calgary, Cummings School of Medicine, Calgary, AB, Canada
| | - Jodie M Burton
- Division of Neurology, Department of Clinical Neurosciences, University of Calgary, Cummings School of Medicine, Calgary, AB, Canada.
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.
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Luo Y, Deng Y, Ran H, Yu L, Ma C, Zhao L, Li Y. Effectiveness and Safety of Immunosuppressive Drug Therapy for Neuromyelitis Optica Spectrum Disorders: An Overview of Meta-Analyses and Systematic Reviews. Curr Neuropharmacol 2023; 21:1827-1834. [PMID: 36154604 PMCID: PMC10514536 DOI: 10.2174/1570159x20666220922151442] [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: 03/12/2022] [Revised: 08/14/2022] [Accepted: 08/16/2022] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE This study aims to provide an overview of meta-analyses and systematic reviews on the effectiveness and safety of immunosuppressive drug therapy for neuromyelitis optica spectrum disorders (NMOSD) by evaluating the methodological quality and reporting quality of reviews. METHODS The Chinese National Knowledge Infrastructure (CNKI), WanFang Data, China Science and Technology Journal Database, Web of Science, the Cochrane Library, PubMed, and Embase databases were searched to collect systematic reviews or meta-analyses on the effectiveness and safety of immunosuppressive therapy for NMOSD from inception to December 2, 2021. Two researchers independently screened reviews and extracted data. Any differences in the procession of review assessment between the two researchers were re-evaluated, and the disagreement was resolved by discussion with other researchers. The following data were extracted: author, year of publication, the country where the study was conducted, study type, the number of included studies, sample size, risk bias tools, medication of immunosuppressive therapy, and main outcomes. Then, the AMSTAR-2, which is a critical appraisal tool for systematic reviews (2nd edition), and Grades of Recommendation, Assessment, Development and Evaluation (GRADE) were used to evaluate the methodological quality and reporting quality of evidence. A comprehensive analysis was conducted on the outcomes for all included reviews. RESULTS A total of 15 reviews were included. Of the included reviews, 3 were systematic reviews, 7 were meta-analyses, and 5 were systematic reviews and meta-analyses. According to the AMSTAR-2 criteria, 6 studies had high quality, 1 study had moderate quality, 4 studies had low quality, and 4 studies had critically low quality. Based on the GRADE, neither evidence quality for effectiveness nor safety was high. CONCLUSION Immunosuppressive drug therapy is effective for patients with NMOSD, but its safety is controversial. Due to the poor quality of evidence, reliability needs to be considered. Thus, large sample, multi-center, double-blind, randomized controlled studies are still needed in the future.
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Affiliation(s)
- Yuan Luo
- The Second Xiangya Hospital of Central South University, Changsha, Hunan Province, 410011, China
- Xiangya School of Nursing, Central South University, Changsha, Hunan Province, 410013, China
| | - Yuqian Deng
- Xiangya School of Nursing, Central South University, Changsha, Hunan Province, 410013, China
| | - Haiye Ran
- Xiangya School of Nursing, Central South University, Changsha, Hunan Province, 410013, China
| | - Lei Yu
- Xiangya School of Medicine, Central South University, Changsha, Hunan Province, 410013, China
| | - Caili Ma
- The Second Xiangya Hospital of Central South University, Changsha, Hunan Province, 410011, China
| | - Liping Zhao
- The Second Xiangya Hospital of Central South University, Changsha, Hunan Province, 410011, China
| | - Yunchen Li
- The Second Xiangya Hospital of Central South University, Changsha, Hunan Province, 410011, China
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Saitakis G, Chwalisz BK. Treatment and Relapse Prevention of Typical and Atypical Optic Neuritis. Int J Mol Sci 2022; 23:9769. [PMID: 36077167 PMCID: PMC9456305 DOI: 10.3390/ijms23179769] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 08/17/2022] [Accepted: 08/18/2022] [Indexed: 12/02/2022] Open
Abstract
Optic neuritis (ON) is an inflammatory condition involving the optic nerve. Several important typical and atypical ON variants are now recognized. Typical ON has a more favorable prognosis; it can be idiopathic or represent an early manifestation of demyelinating diseases, mostly multiple sclerosis (MS). The atypical spectrum includes entities such as antibody-driven ON associated with neuromyelitis optica spectrum disorder (NMOSD) and myelin oligodendrocyte glycoprotein antibody disease (MOGAD), chronic/relapsing inflammatory optic neuropathy (CRION), and sarcoidosis-associated ON. Appropriate and timely diagnosis is essential to rapidly decide on the appropriate treatment, maximize visual recovery, and minimize recurrences. This review paper aims at presenting the currently available state-of-the-art treatment strategies for typical and atypical ON, both in the acute phase and in the long-term. Moreover, emerging therapeutic approaches and novel steps in the direction of achieving remyelination are discussed.
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Affiliation(s)
- George Saitakis
- Division of Neuro-Ophthalmology, Department of Ophthalmology, Massachusetts Eye & Ear Infirmary, Harvard Medical School, Boston, MA 02115, USA
- Athens Eye Hospital, 166 75 Athens, Greece
| | - Bart K. Chwalisz
- Division of Neuro-Ophthalmology, Department of Ophthalmology, Massachusetts Eye & Ear Infirmary, Harvard Medical School, Boston, MA 02115, USA
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, 15 Parkman Street, Suite 835, Boston, MA 02114, USA
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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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Efficacy of rituximab in the treatment of neuromyelitis optica spectrum disorders: An update systematic review and meta -analysis. Mult Scler Relat Disord 2021; 50:102843. [PMID: 33609924 DOI: 10.1016/j.msard.2021.102843] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 01/17/2021] [Accepted: 02/10/2021] [Indexed: 11/23/2022]
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. Rituximab (RTX) is a chimeric monoclonal antibody directed against the surface antigen of CD20 on B lymphocytes and is an emerging treatment option in NMOSD. The present review aimed to conduct an update systematic review and meta-analysis for the efficacy of RTX in the treatment of NMOSD and analyze main factors affecting the efficacy of RTX. 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; 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; (note: literature retrieval operators "AND" "OR" "NOT" are used to link MeSH with Entry Terms.) 54 studies were included in this systematic review and 29 studies were included in meta-analysis. The main efficacy indicators were the difference of the expanded disability status scale (EDSS) and annualized relapse rate (ARR) between before and after rituximab treatments. RESULTS In 29 studies involving 732 patients (643 women, 84 men, 5 with unknown gender), the EDSS and ARR were reduced by an average of -0.57 (95%CI, -0.69 to -0.44), -1.57 (95%CI, -1.78 to -1.35), respectively. CONCLUSION Our systematic review and update meta-analysis provide new evidences that RTX can effectively improve disability and reduce ARR ratio.
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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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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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11
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Wallach AI, Tremblay M, Kister I. Advances in the Treatment of Neuromyelitis Optica Spectrum Disorder. Neurol Clin 2020; 39:35-49. [PMID: 33223088 DOI: 10.1016/j.ncl.2020.09.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Neuromyelitis optica spectrum disorder (NMOSD) is a rare, relapsing-remitting neuroinflammatory disorder of the central nervous system. Advances in the understanding of NMOSD pathogenesis and identification of the NMO-specific pathogenic anti-AQP4 autoantibody have led to the development of highly effective disease-modifying strategies. Five placebo-controlled, randomized trials for NMOSD have been successfully completed as of 2020. These trials support the efficacy of rituximab and tocilizumab and led to the FDA approval of eculizumab, satralizumab and inebilizumab for NMOSD. Our review provides an update on these evidence-based disease-modifying therapies and discussed the treatment of acute relapses in NMOSD.
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Affiliation(s)
- Asya Izraelit Wallach
- Alfiero and Lucia Palestroni MS Comprehensive Care Center, Holy Name Medical Center, 718 Teaneck Road, Teaneck, NJ 07666, USA.
| | - Matthew Tremblay
- MS Comprehensive Care Center, RWJ Barnabas Health, 200 South Orange Avenue, Suite 124-A, Livingston, NJ 07039, USA
| | - Ilya Kister
- Department of Neurology, Comprehensive MS Center, NYU Grossman School of Medicine, 240 East 38th Street, New York, NY 10016, USA
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Guan Y, Jiang S, Ye W, Ren X, Wang X, Zhang Y, Yin M, Wang K, Tao Y, Yang J, Cao D, Cheng Y. Combined treatment of mitoxantrone sensitizes breast cancer cells to rapalogs through blocking eEF-2K-mediated activation of Akt and autophagy. Cell Death Dis 2020; 11:948. [PMID: 33144562 PMCID: PMC7642277 DOI: 10.1038/s41419-020-03153-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 10/15/2020] [Accepted: 10/19/2020] [Indexed: 02/07/2023]
Abstract
Oncogenic activation of the mTOR signaling pathway occurs frequently in tumor cells and contributes to the devastating features of cancer, including breast cancer. mTOR inhibitors rapalogs are promising anticancer agents in clinical trials; however, rapalogs resistance remains an unresolved clinical challenge. Therefore, understanding the mechanisms by which cells become resistant to rapalogs may guide the development of successful mTOR-targeted cancer therapy. In this study, we found that eEF-2K, which is overexpressed in cancer cells and is required for survival of stressed cells, was involved in the negative-feedback activation of Akt and cytoprotective autophagy induction in breast cancer cells in response to mTOR inhibitors. Therefore, disruption of eEF-2K simultaneously abrogates the two critical resistance signaling pathways, sensitizing breast cancer cells to rapalogs. Importantly, we identified mitoxantrone, an admitted anticancer drug for a wide range of tumors, as a potential inhibitor of eEF-2K via a structure-based virtual screening strategy. We further demonstrated that mitoxantrone binds to eEF-2K and inhibits its activity, and the combination treatment of mitoxantrone and mTOR inhibitor resulted in significant synergistic cytotoxicity in breast cancer. In conclusion, we report that eEF-2K contributes to the activation of resistance signaling pathways of mTOR inhibitor, suggesting a novel strategy to enhance mTOR-targeted cancer therapy through combining mitoxantrone, an eEF-2K inhibitor.
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Affiliation(s)
- Yidi Guan
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, 410011, Changsha, Hunan, China
| | - Shilong Jiang
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, 410011, Changsha, Hunan, China
| | - Wenling Ye
- Xiangya School of Pharmaceutical Sciences, Central South University, 410008, Changsha, Hunan, China
| | - Xingcong Ren
- Department of Cancer Biology and Toxicology, Department of Pharmacology, College of Medicine, Markey Cancer Center, University of Kentucky, Lexington, KY, 40536, USA
| | - Xinluan Wang
- Translational Medicine R&D Center, Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, 518057, Shenzhen, China
| | - Yi Zhang
- Department of Pharmacology, College of Pharmaceutical Sciences, Soochow University, Suzhou, China
| | - Mingzhu Yin
- Department of Dermatology, Hunan Engineering Research Center of Skin Health and Disease, Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, 410008, Changsha, Hunan, China
| | - Kuansong Wang
- Department of Pathology, Xiangya Hospital, Central South University, 410078, Changsha, China
| | - Yongguang Tao
- Cancer Research Institute, School of Basic Medicine, and Key Laboratory of Carcinogenesis and Cancer Invasion, Ministry of Education, Central South University, 410008, Changsha, Hunan, China
| | - JinMing Yang
- Department of Cancer Biology and Toxicology, Department of Pharmacology, College of Medicine, Markey Cancer Center, University of Kentucky, Lexington, KY, 40536, USA
| | - Dongsheng Cao
- Xiangya School of Pharmaceutical Sciences, Central South University, 410008, Changsha, Hunan, China.
| | - Yan Cheng
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, 410011, Changsha, Hunan, China.
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Han M, Chen Y, Nong L, Liu Z, Hao L, Wang Z. Safety and efficacy of plasma exchange for the treatment of optic neuritis in neuromyelitis optica spectrum disorders: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e21067. [PMID: 32664124 PMCID: PMC7360232 DOI: 10.1097/md.0000000000021067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 06/03/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Neuromyelitis optica spectrum disorders (NMOSD) is an inflammatory and heterogeneous astrocyte disorder of the central nervous system (CNS), concerned because of its high pathogenicity, high risk of recurrence, and poor prognosis. Optic neuritis (ON) is the first manifestation in 30% to 50% of NMOSD patients, and eventually involved optic nerve in 70% of patients. The idiopathic ON associated with NMO is called NMO-associated ON(NMO-ON). There are substantial costs to the countries and individuals associated with treatment of NMO-ON. Intravenous corticosteroids (IVCSs), as the first-line therapy, leads to unsatisfactory outcomes for NMO-ON and is associated with potential adverse events (AEs). Emerging evidences have proved the important value and potential prospect of plasma exchange (PLEX) in NMO-ON. Although PLEX is increasingly used in NMO-ON, its therapeutic effect and safety are still controversial. There are no systematic reviews yet that evaluated the effects of PLEX against other therapies in patients with NMO-NO. It is therefore timely to perform a systematic review to assess the efficacy and safety of PLEX on current research for its potential use in clinical practice in treating NMO-ON. METHODS The systematic review will include all of the randomized controlled trials (RCT) on the efficacy and safety of PLEX for NMO-ON. A relevant literature search by sensitive search strategies was conducted using the following electronic databases from their inception to November 30, 2019: PubMed, Web of Science, EMBASE, the Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang Database, China Science and Technology Journal database (VIP) and CBM. We will also search registers of clinical trials, potential gray literature, and conference abstracts. There are no limits on language and publication status. The literature screening, data extraction, and quality assessment will be conducted by 2 reviewers independently. The reporting quality and risk of bias will be assessed by other 2 researchers. Best-corrected visual acuity (BCVA), annualized relapse rate (ARR), the frequency and extent of adverse events (AEs) will be evaluated as the primary outcome. The secondary outcomes will include expanded disability status scales (EDSS), relapse-free rate, peri-papillary retinal nerve fibers layer (pRNFL) or macular volume, visual electrophysiology examinations, standard automated perimetry examinations, time to the next attack. Meta-analysis will be performed using RevMan5.3 software provided by the Cochrane Collaboration and Stata 12.0. RESULTS This study will provide a comprehensive review based on current evidence of PLEX treatment for NMO-ON in several aspects, including BCVA, ARR, the frequency and extent of adverse events (AEs), EDSS, relapse-free rate, etc. CONCLUSION:: The conclusion of this study will provide evidence to determine whether PLEX is an effective and safe intervention for patients with NMO-ON. ETHICS AND DISSEMINATION It is not necessary to obtain ethical approval for this study, given that this protocol is for a systematic review. 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 PROSPERO CRD 42020162585.
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Affiliation(s)
- Mengyu Han
- Graduate School, Beijing University of Chinese Medicine
- Department of Ophthalmology, China-Japan Friendship Hospital, Beijing, China
| | - You Chen
- Department of Ophthalmology, China-Japan Friendship Hospital, Beijing, China
| | - Luqi Nong
- Graduate School, Beijing University of Chinese Medicine
- Department of Ophthalmology, China-Japan Friendship Hospital, Beijing, China
| | - Ziqiang Liu
- Graduate School, Beijing University of Chinese Medicine
- Department of Ophthalmology, China-Japan Friendship Hospital, Beijing, China
| | - Lu Hao
- Science and education Department, Shenzhen Baoan Shiyan People's Hospital, Shenzhen
| | - Zhijun Wang
- Department of Ophthalmology, China-Japan Friendship Hospital, Beijing, China
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