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Cao S, Zhu Y, Wu X, Du J, Xu S, Cui P, Li Q, Xia M, Xue Q, Tian Y. Asymptomatic spinal lesions in patients with AQP4-IgG-positive NMOSD: A real-world cohort study. Ann Clin Transl Neurol 2024; 11:905-915. [PMID: 38311755 PMCID: PMC11021673 DOI: 10.1002/acn3.52007] [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: 12/05/2023] [Revised: 01/10/2024] [Accepted: 01/10/2024] [Indexed: 02/06/2024] Open
Abstract
OBJECTIVE This study aims to explore the frequency and influencing factors of asymptomatic spinal lesions (ASLs) and their impact on subsequent relapses in patients with AQP4-IgG-positive NMOSD (AQP4-NMOSD) in a real-world setting. METHODS We retrospectively reviewed clinical information and spinal MRI data from AQP4-NMOSD patients who had at least one spinal cord MRI during their follow-ups. Kaplan-Meier curves and Cox proportional hazards models were employed to ascertain potential predictors of remission ASLs and to investigate factors associated with subsequent relapses. RESULTS In this study, we included 129 patients with AQP4-NMOSD and reviewed 173 spinal MRIs during attacks and 89 spinal MRIs during remission. Among these, 6 ASLs (3.5%) were identified during acute attacks, while 8 ASLs (9%) were found during remission. Remission ASLs were linked to the use of immunosuppressive agents, particularly conventional ones, whereas no patients using rituximab developed ASLs (p = 0.005). Kaplan-Meier curve analysis indicated that patients with ASLs had a significantly higher relapse risk (HR = 4.658, 95% CI: 1.519-14.285, p = 0.007) compared to those without. Additionally, the use of mycophenolate mofetil (HR = 0.027, 95% CI: 0.003-0.260, p = 0.002) and rituximab (HR = 0.035, 95% CI: 0.006-0.203, p < 0.001) significantly reduced the relapse risk. However, after accounting for other factors, the presence of ASLs did not exhibit a significant impact on subsequent relapses (HR = 2.297, 95% CI: 0.652-8.085, p = 0.195). INTERPRETATION ASLs may be observed in patients with AQP4-NMOSD. The presence of ASLs may signify an underlying inflammatory activity due to insufficient immunotherapy. The administration of immunosuppressive agents plays a key role in the presence of remission ASLs and the likelihood of subsequent relapses.
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Affiliation(s)
- Shugang Cao
- Department of NeurologySecond Affiliated Hospital of Anhui Medical UniversityHefei230601China
- Department of NeurologyThe Second People's Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical UniversityHefei230011China
| | - Yunfei Zhu
- Department of NeurologyFirst Affiliated Hospital of Soochow UniversitySuzhou215006China
| | - Xiaosan Wu
- Department of NeurologySecond Affiliated Hospital of Anhui Medical UniversityHefei230601China
| | - Jing Du
- Department of NeurologySecond Affiliated Hospital of Anhui Medical UniversityHefei230601China
| | - Si Xu
- Department of NeurologySecond Affiliated Hospital of Anhui Medical UniversityHefei230601China
| | - Ping Cui
- Department of RadiologyThe Second People's Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical UniversityHefei230011China
| | - Qi Li
- Department of NeurologySecond Affiliated Hospital of Anhui Medical UniversityHefei230601China
| | - Mingwu Xia
- Department of NeurologyThe Second People's Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical UniversityHefei230011China
| | - Qun Xue
- Department of NeurologyFirst Affiliated Hospital of Soochow UniversitySuzhou215006China
| | - Yanghua Tian
- Department of NeurologySecond Affiliated Hospital of Anhui Medical UniversityHefei230601China
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Carnero Contentti E, Lopez PA, Tkachuk V, Vrech C, Zarate MA, Correale J, Deri N, Luetic G, Marrodan M, Pagani Cassara F, Tavolini D, Ysrraelit MC, Balbuena ME, Hryb J, Chiganer E, Leguizamon F, Knorre E, Zanga G, Pestchanker C, Barboza A, Nadur D, Cristiano E, Patrucco L, Alonso R, Alonso Serena M, Paul F, Rojas JI. Frequency of new asymptomatic MRI lesions during attacks and follow-up of patients with NMOSD in a real-world setting. Mult Scler 2023; 29:1240-1249. [PMID: 37491849 DOI: 10.1177/13524585231187120] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
BACKGROUND We aimed to assess the frequency of new asymptomatic lesions on brain and spinal imaging (magnetic resonance imaging (MRI)) and their association with subsequent relapses in a large cohort of neuromyelitis optica spectrum disorder (NMOSD) patients in Argentina. METHODS We retrospectively reviewed 675 MRI (225 performed during an attack and 450 during the relapse-free period (performed at least 3 months from the last attack)) of NMOSD patients who had at least 2 years of clinical and MRI follow-up since disease onset. Kaplan-Meier (KM) curves were used for depicting time from remission MRI to subsequent relapse. RESULTS We included 135 NMOSD patients (64.4% were aquaporin-4-immunoglobulin G (AQP4-IgG)-positive). We found that 26 (19.26%) and 66 (48.88%) of patients experienced at least one new asymptomatic MRI lesion during both the relapse-free period and attacks, respectively. The most frequent asymptomatic MRI lesions were optic nerves followed by short-segment myelitis during the relapse-free period and attacks. KM curves did not show differences in the time taken to develop a new relapse. CONCLUSION Our findings showed that new asymptomatic lesions are relatively frequent. However, the presence of new asymptomatic MRI lesions during the relapse-free period and at relapses was not associated with a shorter time to developing subsequent relapses.
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Affiliation(s)
| | - Pablo A Lopez
- Neuroimmunology Unit, Department of Neurosciences, Hospital Alemán, Buenos Aires, Argentina
| | - Verónica Tkachuk
- Sección de Neuroinmunología y Enfermedades Desmielinizantes, Servicio de Neurología, Hospital de Clínicas José de San Martín, Buenos Aires, Argentina
| | - Carlos Vrech
- Departamento de Enfermedades Desmielinizantes, Sanatorio Allende, Córdoba, Argentina
| | - María A Zarate
- Departamento de Enfermedades Desmielinizantes, Sanatorio Allende, Córdoba, Argentina
| | - Jorge Correale
- Departamento de Neurología, Fleni, Buenos Aires, Argentina
| | - Norma Deri
- Centro de Especialidades Neurológicas y Rehabilitación, CENyR, Buenos Aires, Argentina
| | | | | | - Fátima Pagani Cassara
- Instituto de Neurociencias, Fundación Favaloro/INECO/Buenos Aires, Argentina Servicio de Neurología, Hospital Universitario Austral, Buenos Aires, Argentina
| | | | | | - María E Balbuena
- Sección de Neuroinmunología y Enfermedades Desmielinizantes, Servicio de Neurología, Hospital de Clínicas José de San Martín, Buenos Aires, Argentina
| | - Javier Hryb
- Consultorio de Neuroinmunología, Hospital Carlos G. Durand, Buenos Aires, Argentina
| | - Edson Chiganer
- Consultorio de Neuroinmunología, Hospital Carlos G. Durand, Buenos Aires, Argentina
| | | | - Eduardo Knorre
- Hospital de Agudos, Dr. Teodoro Álvarez, Buenos Aires, Argentina
| | - Gisela Zanga
- Departamento de Neurología, Hospital Cesar Milstein, Buenos Aires, Argentina
| | | | | | - Débora Nadur
- Sección de Neuroinmunología y Enfermedades Desmielinizantes, Servicio de Neurología, Hospital de Clínicas José de San Martín, Buenos Aires, Argentina
| | - Edgardo Cristiano
- Centro de Esclerosis Múltiple de Buenos Aires, Buenos Aires, Argentina
| | - Liliana Patrucco
- Centro de Esclerosis Múltiple de Buenos Aires, Buenos Aires, Argentina
| | - Ricardo Alonso
- Centro Universitario de Esclerosis Múltiple, Hospital Ramos Mejía, Buenos Aires, Argentina
| | - Marina Alonso Serena
- Servicio de Clínica Médica, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Friedemann Paul
- NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Freie Universität Berlin, Berlin, Germany
- Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin Institute of Health, Berlin, Germany
- Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Juan Ignacio Rojas
- Centro de Esclerosis Múltiple de Buenos Aires, Buenos Aires, Argentina Servicio de Neurología, Unidad de EM y Enfermedades Desmielinizantes, Hospital Universitario de CEMIC, Buenos Aires, Argentina
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