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Ashtari F, Mehdipour R, Eini A, Ghalamkari A. Epidemiologic and clinical characteristics of neuromyelitis optica spectrum disorder patients, A seven years follow-up study from Iran. Mult Scler Relat Disord 2023; 77:104852. [PMID: 37399672 DOI: 10.1016/j.msard.2023.104852] [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: 12/09/2022] [Revised: 06/15/2023] [Accepted: 06/22/2023] [Indexed: 07/05/2023]
Abstract
BACKGROUND Neuromyelitis Optica Spectrum Disorder (NMOSD) is a rare neuroinflammatory disease characterized by recurrent relapses. The most common signs are myelitis and optic neuritis. It can also present by cerebral or brain stem syndromes. There are still many challenges in its diagnosis and treatment, and long-term follow-up studies are needed to see the disease course over time. METHODS We established an electronic registration system of NMOSD patients starting from October 2015 in Kashani hospital, Isfahan, Iran. Every suspected patient was documented and included in the follow-up system to survey their disease course. Anti-aquaporine 4 (AQP4) antibody checked for all by cell-based assay method. All information such as demographic and clinical data and laboratory and MRI findings were documented. Participants were followed up for any relapses, new paraclinical tests and drug changes. This study is based on the definite NMOSD cases (according to the 2015 criteria) characteristics and clinical course during 7 years of registration. RESULTS The study included 173 NMOSD cases and 56 ones were seropositive for AQP4 Ab. Their mean age was 40.02±11.11 years (45.78 in the seropositive group). The mean age at disease onset was about 30.16 years. The mean time of follow-up by our registration system is 55.84 ± 18.94 months (54.82 months in seropositive ones). The annual relapse rate is estimated as 0.47±0.36. Long extended transvers myelitis (LETM) was present in the baseline MRI of 77 patients (44.5%), while 32 of them did not show any related clinical symptoms. 124 patients revealed an abnormality in the first brain MRI. 27 individuals suffer hypothyroidism as the most common comorbid disease. The disease seems to be more prevalent in the west and southwest areas of Isfahan province. CONCLUSION The mean age of onset is higher than Multiple Sclerosis (MS) patients, but there are notable pediatric cases too. It should also be noticed that cervical LETM can be asymptomatic at first. Brain MRI abnormalities are frequently observed. The disease is more prevalent in the geographical areas where showing high MS prevalence.
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Affiliation(s)
- Fereshteh Ashtari
- Neurology Department(,)Isfahan Neuroscience Research Center(,)Isfahan University of Medical Science(,) Iran
| | - Roshanak Mehdipour
- Isfahan Neuroscience Research Center(,) Isfahan University of Medical Science(,)Iran.
| | - Ahmad Eini
- Isfahan Neuroscience Research Center(,) Isfahan University of Medical Science(,)Iran
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Cutler C, Azab MA, Lucke-Wold B, Khan M, Henson JC, Gill AS, Alt JA, Karsy M. Systematic Review of Treatment Options and Therapeutic Responses for Lesions of the Sella and Orbit: Evidence-Based Recommendations. World Neurosurg 2023; 173:136-145.e30. [PMID: 36639102 DOI: 10.1016/j.wneu.2022.12.108] [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: 10/20/2022] [Revised: 12/26/2022] [Accepted: 12/26/2022] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Inflammatory pathologies of the sella and orbit are rare but require prompt diagnosis to initiate effective treatment. Because uniform recommendations for treatment are currently lacking, we performed an evidence-based review to identify recommendations. METHODS We performed a literature search of the PubMed, Embase, and Web of Science databases to identify papers evaluating treatment of inflammatory pathologies of the sella and orbit. We used PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines to define recommendations, specifically examining aggregated sample sizes, disease-specific patient follow-up, and clinical trials focused on inflammatory diseases of the sella and orbit. RESULTS A total of 169 studies were included and organized by disease pathology. Treatments for various pathologies were recorded. Treatment options included surgery, radiation, steroids, targeted treatments, immunomodulators, intravenous immune globulin, and plasmapheresis. Steroids were the most often employed treatment, second-line management options and timing varied. Pathological diagnosis was highly associated with treatment used. Most evidence were level 3 without available control groups, except for 13 trials in neuromyelitis optica with level 1 or 2 evidence. CONCLUSIONS This is the first evidence-based review to provide recommendations on specific treatments for pathologies of the orbit and sella. The reported data may be useful to help guide randomized clinical trials and provide resource for clinical management decisions based on the available evidence.
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Affiliation(s)
- Christopher Cutler
- Chicago Medical School at Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, USA
| | - Mohammed A Azab
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA
| | - Brandon Lucke-Wold
- Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
| | - Majid Khan
- Reno School of Medicine, University of Nevada, Reno, Nevada, USA
| | - J Curran Henson
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Amarbir S Gill
- Division of Otolaryngology, Department of Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Jeremiah A Alt
- Division of Otolaryngology, Department of Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Michael Karsy
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA.
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Different doses of Rituximab for the therapy of Neuromyelitis optica spectrum disorder: A systematic review and meta-analysis. Mult Scler Relat Disord 2022; 68:104127. [PMID: 36044828 DOI: 10.1016/j.msard.2022.104127] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 07/27/2022] [Accepted: 08/16/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Neuromyelitis optica spectrum disease(NMOSD) is an autoimmune neurological disease that primarily affects the spinal cord, optic nerve, and periventricular organs. Rituximab plays an important role in the prevention of relapse in NMOSD. In this study, we evaluated the efficacy and safety of different doses of the anti-monoclonal antibody rituximab in NMOSD. OBJECTS Our study aimed to implement a meta-analysis to systematically assess the efficacy and safety of different doses of rituximab in the treatment of NMOSD. METHODS We searched Pubmed, Embase, the Cochrane Library, and Clinicaltrials.gov for relevant studies evaluating rituximab for NMOSD up to March 2022. Data were assessed using Review Manager 5.3 and Stata 14 softwares. Means and standard deviations(SD) were analyzed using random effects models with continuous outcomes. Risk radio was analyzed using random effects models with dichotomous outcomes. RESULTS We collected 576 patients from 17 studies. The endpoint of efficacy was the change in annual recurrence rate(ARR), expanded disability status scale (EDSS), and the number of patients free of relapse between pre-treatment and post-treatment of rituximab. We found that rituximab reduced ARR and EDSS, with a significant reduction in ARR(MD= -1.79, 95% CI: -3.18 ∼ -0.39, P= 0.01) and EDSS(MD= -1.35, 95% CI: -1.5 ∼ -1.19, P < 0.00001) at 100 mg intravenous infusion per week for 3 consecutive weeks, meanwhile making the number of patients free of relapse increased (RR= 24.61 [5.11, 118.55], P<0.0001) and being relatively safe and without serious adverse events(SAEs). In terms of safety, we compared and summarised the adverse events(AEs) and SAEs from 17 studies. CONCLUSION In this study, we found rituximab to be relatively safe and efficacious in the treatment of NMOSD, particularly at a dose of 100mg intravenous infusion per week for 3 consecutive weeks.
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Uzunköprü C, Tütüncü M, Gündüz T, Gümüş H, Şen S, Demir S, Çınar BP, Türe HS, Uygunoğlu U, Toğrol RE, Terzi M, Kürtüncü M, Özakbaş S, Tütüncü M, Beckmann Y, Siva A. The efficacy of rituximab in patients with neuromyelitis optica spectrum disorder: A real-world study from Turkey. Int J Clin Pract 2021; 75:e14158. [PMID: 33743552 DOI: 10.1111/ijcp.14158] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 03/17/2021] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Neuromyelitis optica spectrum disorders (NMOSD) are a group of antibody-mediated chronic inflammatory diseases of the central nervous system. Rituximab is a monoclonal antibody that leads to a reduction in disease activity. OBJECTIVE To evaluate the efficacy of rituximab as monotherapy in NMOSD and to determine whether the efficacy varies depending on the presence of antibodies in this cohort. METHOD This multicentre national retrospective study included patients with NMOSD treated with rituximab at least for 12 months from Turkey. The primary outcomes were the change in the annualised relapse rate, the Expanded Disability Status Scale (EDSS), the number of relapse and radiological activity-free patients. RESULTS A total of 85 patients with NMOSD were included in the study. Of 85 patients, 58 (68.2%) were seropositive for anti-Aquaporin4-IgG (antI-AQP4-IgG). All patients were Anti-Myelin Oligodendrocyte Glycoprotein IgG (anti-MOG-IgG) negative. The median follow-up for rituximab treatment was 21 months (Q1 16-Q3 34.5). During rituximab treatment, the mean annualised relapse rate (ARR) significantly decreased from 1.45 ± 1.53 to 0.15 ± 0.34 (P < .001). In subgroup analyses, the mean ARR decreased from 1.61 ± 1.65 to 0.20 ± 0.39 in the seropositive group and 1.10 ± 1.19 to 0.05 ± 0.13 in the seronegative group. The mean EDSS improved from 3.98 ± 2.04 (prior to treatment onset) to 2.71 ± 1.59 (at follow-up) (P < .001). In the seropositive group, mean EDSS decreased from 3.94 ± 1.98 to 2.67 ± 1.54, and in the seronegative group, mean EDSS decreased from 4.07 ± 2.21 to 2.79 ± 1.73. There was no significant difference between anti-AQP4-IgG (+) and (-) groups in terms of ARR and EDSS. Sixty-four patients (75.2%) were relapse-free after the initiation of treatment. Seventy patients (82.3%) were radiological activity-free in the optic nerve, area postrema and brainstem. Additionally, 78 patients (91.7%) showed no spinal cord involvement after the treatment. CONCLUSION Rituximab therapy is efficacious in the treatment of Turkish NMOSD patients independent of the presence of the anti-AQP4-IgG antibody.
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Affiliation(s)
- Cihat Uzunköprü
- Department of Neurology, Faculty of Medicine, İzmir Katip Çelebi University, Izmir, Turkey
| | - Melih Tütüncü
- Department of Neurology, Cerrahpaşa School of Medicine, Istanbul University, Istanbul, Turkey
| | - Tuncay Gündüz
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Haluk Gümüş
- Department of Neurology, Faculty of Medicine, Konya Selçuk University, Konya, Turkey
| | - Sedat Şen
- Department of Neurology, Faculty of Medicine, Samsun 19 Mayıs University, Samsun, Turkey
| | - Serkan Demir
- Department of Neurology, Sancaktepe Şehit Prof. Dr. İlhan Varank Training and Research Hospital, Istanbul, Turkey
| | - Bilge Piri Çınar
- Department of Neurology, Faculty of Medicine, Bülent Ecevit University, Zonguldak, Turkey
| | - Hatice Sabiha Türe
- Department of Neurology, Faculty of Medicine, İzmir Katip Çelebi University, Izmir, Turkey
| | - Uğur Uygunoğlu
- Department of Neurology, Cerrahpaşa School of Medicine, Istanbul University, Istanbul, Turkey
| | - Rıfat Erdem Toğrol
- Department of Neurology, Sultan Abdülhamid Han Training and Research Hospital, Istanbul, Turkey
| | - Murat Terzi
- Department of Neurology, Faculty of Medicine, Samsun 19 Mayıs University, Samsun, Turkey
| | - Murat Kürtüncü
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Serkan Özakbaş
- Department of Neurology, Faculty of Medicine, 9 Eylül University, Izmir, Turkey
| | - Mesude Tütüncü
- Department of Neurology, Prof Dr Mazhar Osman Mental Health and Neurology Training and Research Hospital, Istanbul, Turkey
| | - Yeşim Beckmann
- Department of Neurology, Faculty of Medicine, İzmir Katip Çelebi University, Izmir, Turkey
| | - Aksel Siva
- Department of Neurology, Cerrahpaşa School of Medicine, Istanbul University, Istanbul, Turkey
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Correa-Díaz EP, Torres-Herrán GE, Miño Zambrano JE, Paredes-Gonzalez V, Caiza-Zambrano FJ. Impact of Rituximab on relapse rate and disability in an Ecuadorian cohort of patients with neuromyelitis optica spectrum disorders. Mult Scler Relat Disord 2020; 48:102683. [PMID: 33338945 DOI: 10.1016/j.msard.2020.102683] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 11/29/2020] [Accepted: 12/06/2020] [Indexed: 01/17/2023]
Abstract
BACKGROUND Neuromyelitis Optica Spectrum Disorder (NMOSD) is a severe inflammatory demyelinating disease of the central nervous system that often causes disability. Based on evidence from prospective and retrospective studies, Rituximab (RTX) has been used as the first-line of therapy in NMOSD. Nevertheless, evidence of the impact of RTX on relapse rate and disability in Ecuadorian patients with NMOSD is lacking. OBJECTIVE To evaluate the impact of RTX in an Ecuadorian cohort of patients with NMOSD. MATERIALS AND METHODS A retrospective study was conducted in a cohort of patients with NMOSD who received treatment with RTX in a third-level hospital in Quito, Ecuador. Digital medical records of NMOSD patients were reviewed to attain sociodemographic data, disease characteristics, and treatment with RTX. The annualized relapse rate ARR, as well as the degree of disability measured through the expanded disability scale (EDSS), was established before and after treatment. RESULTS Twenty-three patients with NMOSD treated with RTX were included, the mean age of onset of the disease was 37.2 years (range, 13-64.5). The average duration of disease was 8.5 years (range, 1.3-34.4). Positivity for antibodies against aquaporin-4 (AQP4-IgG) was identified in 78% of the patients. The mean duration of the treatment with RTX was 40 months (range, 12-61). After the RTX therapy, the number of relapses was reduced in 91% (21/23) of cases. The annualized relapsed rate (ARR) was reduced with RTX from 1.89 to 0.12 (p <0.001). The mean EDSS was also reduced from 4.8 to 3.9 (p = 0.014). In all patients, the mean EDSS was reduced or stabilized with RTX. Overall, the drug was well tolerated, the most frequent adverse events were infections which were present in 65.2% of cases. CONCLUSIONS Though with the limitations of and observational study, our data support RTX effectiveness and safety in an Ecuadorian cohort of patients with NMOSD.
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Paul S, Mondal GP, Bhattacharyya R, Ghosh KC, Bhat IA. Neuromyelitis optica spectrum disorders. J Neurol Sci 2020; 420:117225. [PMID: 33272591 DOI: 10.1016/j.jns.2020.117225] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 11/05/2020] [Accepted: 11/09/2020] [Indexed: 12/11/2022]
Abstract
The disease concept of Neuromyelitis Optica Spectrum Disorders(NMOSD) has undergone a significant change over the last two decades including the detection of Myelin Oligodendrocyte Glycoprotein(MOG) antibody in patients who are seronegative for aquaporin-4 antibody. Aquaporin-4 antibody positive NMOSD is now regarded as an immune astrocytopathy. Conversely, MOG antibody associated disease is known to target myelin rather than astrocytes, leading to an NMOSD syndrome with distinct clinical and radiological features. Incorporation of clinical features like area postrema syndrome, brainstem syndrome, diencephalic syndrome and cortical manifestations as core clinical characteristics into the revised diagnostic criteria has widened the clinical spectrum of NMOSD. With the development of these criteria, it is possible to make the diagnosis at an earlier stage so that effective immunosuppression can be instituted promptly for a better long-term prognosis. Newer therapeutic agents have been introduced for aquaporin-4 seropositive NMOSD disease; however, challenges remain in treating seronegative disease because of limited treatment options.
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Affiliation(s)
- Shabeer Paul
- Department of Neurology Calcutta National Medical College Hospital, Kolkata, West Bengal 700014, India.
| | - Gouranga Prasad Mondal
- Department of Neurology Calcutta National Medical College Hospital, Kolkata, West Bengal 700014, India.
| | - Ramesh Bhattacharyya
- Department of Neurology Calcutta National Medical College Hospital, Kolkata, West Bengal 700014, India.
| | - Kartik Chandra Ghosh
- Department of Neurology Calcutta National Medical College Hospital, Kolkata, West Bengal 700014, India.
| | - Imtiyaz Ahmad Bhat
- Department of Immunology & Molecular Medicine, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Kashmir 190011, India.
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Xue T, Yang Y, Lu Q, Gao B, Chen Z, Wang Z. Efficacy and Safety of Monoclonal Antibody Therapy in Neuromyelitis Optica Spectrum Disorders: Evidence from Randomized Controlled Trials. Mult Scler Relat Disord 2020; 43:102166. [DOI: 10.1016/j.msard.2020.102166] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 04/10/2020] [Accepted: 04/27/2020] [Indexed: 12/13/2022]
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