Aquaporin-4 serostatus does not predict response to immunotherapy in neuromyelitis optica spectrum disorders

Mealy, Maureen A.; Kim, Su Hyun; Schmidt, Felix; López, Reydmar; Arango, Jorge Andrés Jiménez; Paul, Friedemann; Wingerchuk, Dean M.; Greenberg, Benjamin; Kim, Ho Jin; Lévy, Michaël

doi:10.1177/1352458517730131

Cited by 45 publications

(41 citation statements)

References 21 publications

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“…[20]. The proportion of steroid use ranged from 0% [21] to 100% [16,22,23]. In four studies [16,22,23,18], 177 patients (22.2%) had been taking oral corticosteroid at the time of MMF treatment.…”

Section: Demographic and Clinical Characteristicsmentioning

confidence: 99%

“…In four studies [16,22,23,18], 177 patients (22.2%) had been taking oral corticosteroid at the time of MMF treatment. Two studies [21,24] were conducted with 160 patients (20.0%) who did not receive corticosteroid during MMF treatment. The remaining 10 studies contained both groups of patients.…”

Section: Demographic and Clinical Characteristicsmentioning

confidence: 99%

“…The e cacy of MMF treatment determined by changes in ARR and EDSS is shown in Table 2. The median follow-up duration ranged from 13.5 months [22] to 95 months [21], with less than 24 months in 8 studies and 24 months or more in 7 studies. ( Table 1) [24,16,13,19] reporting ARR and 3 studies [24,16,13] reporting EDSS reported values by mean and SD, and therefore were included in the meta-analysis.…”

Section: Treatment Outcome Analysismentioning

confidence: 99%

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Efficacy and Safety of Mycophenolate Mofetil Therapy in Neuromyelitis Optica Spectrum Disorders: A Systematic Review and Meta-Analysis

Songwisit

Kosiyakul

Jitprapaikulsan

et al. 2020

Preprint

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Abstract Background: Neuromyelitis optica spectrum disorders (NMOSD) is an autoimmune demyelinating disease of the central nervous system characterized by severe attacks of optic nerve and spinal cord. Mycophenolate mofetil (MMF) is an immunosuppressive agent (IS) which is widely prescribed for NMOSD patients. This systematic review and meta-analysis aims to assess the efficacy and safety of MMF in controlling relapse and disease severity.Methods: Studies were obtained from the EMBASE and Ovid MEDLINE databases. Eligible studies were the studies of NMOSD patients treated with MMF which reported treatment outcomes as Annualized Relapse Rate (ARR) or Expanded Disability Status Scale (EDSS) before and after treatment. Case reports, case series less than 3 patients, and reviews were excluded.Results: Fifteen studies included 1047 patients, of whom 915 (87.4%) were aquaporin-4 immunoglobulin seropositive. The total number of patients that received MMF was 799. Meta-analysis on ARR and EDSS were conducted in 4 studies with a total of 200 patients and 3 studies with a total of 158 patients, respectively. The result showed a significant improvement with a mean reduction of 1.13 (95% confidence interval (CI), 0.60 to 1.65) in ARR and a mean reduction of 0.85 (95% CI, 0.36 to 1.34) in EDSS after MMF therapy. Adverse drug reactions occurred in 106 (17.8%) of 594 patients that were documented having side effects during MMF therapy.Conclusion: This systematic review and meta-analysis showed that using MMF as a preventive therapy in NMOSD patients can significantly reduce relapse rate and improve disease severity with an acceptable tolerability.

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Section: Demographic and Clinical Characteristicsmentioning

confidence: 99%

Section: Demographic and Clinical Characteristicsmentioning

confidence: 99%

Section: Treatment Outcome Analysismentioning

confidence: 99%

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Efficacy and Safety of Mycophenolate Mofetil Therapy in Neuromyelitis Optica Spectrum Disorders: A Systematic Review and Meta-Analysis

Songwisit

Kosiyakul

Jitprapaikulsan

et al. 2020

Preprint

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“…Furthermore, the levels of AQP4 and MOG antibodies may vary during the course of the disease. However, AQP4 antibody titers do not seem to predict long-term disease duration, and the serum AQP4 antibody status does not predict immunotherapy response [30,31] .…”

Section: Introductionmentioning

confidence: 94%

Current immunotherapies for multiple sclerosis and neuromyelitis optica spectrum disorders: the similarities and differences

Zhang¹,

Tian²,

Li³

2019

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“…The high specificity for AQP4‐IgG gives a strong basis for the NMOSD diagnosis. However, quantitative AQP4‐IgG levels do not predict response to therapy (Mealy et al, ) or overall long‐term outcome of NMOSD (Kessler et al, ). AQP4‐IgG is not detected in 10%–40% of patients diagnosed with NMOSD, (Weinshenker & Wingerchuk, ) based on the availability of assays with high specificity and variable sensitivity (Melamed et al, ).…”

Section: Introductionmentioning

confidence: 99%

Epidemiology of neuromyelitis optica spectrum disorder in Denmark (1998–2008, 2007–2014)

et al. 2019

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Epidemiological studies of the uncommon disorder neuromyelitis optica spectrum disorder (NMOSD) may be difficult to interpret because of the evolving nature of diagnostic criteria, differences in the definition and accuracy of NMOSD diagnosis, the completeness of case ascertainment, and variability in assays for the disease‐specific biomarker aquaporin‐4 (AQP4)‐IgG. A sub‐group of patients with the clinical syndrome NMOSD lack detectable AQP4‐IgG and in these cases an accurate diagnosis requires precise diagnostic algorithms and longitudinal follow‐up. Consecutive sets of criteria for NMO/NMOSD have been introduced during the two last decades. Such criteria need validation in different populations. Detection of other autoantibodies, such as IgG specific for myelin oligodendrocyte glycoprotein or for glial fibrillary acidic protein in a sub‐group of AQP4‐IgG–negative NMOSD patients, has improved over the past decade and may lead to overlap of the clinical syndromes/phenotypes. This review begins by summarizing current knowledge on the widening clinical spectrum of NMOSD. Subsequently, we describe two epidemiological studies from Denmark carried out in two different decades (1998–2008 and 2007–2014) and comment on the differences in study design, patient ascertainment, and interpretation of results. These factors may explain some of the observed differences, reflecting the complexity and providing a clear example of this development.

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Aquaporin-4 serostatus does not predict response to immunotherapy in neuromyelitis optica spectrum disorders

Abstract: In this international collaboration involving a large number of neuromyelitis optica spectrum disorder patients, treatment was effective regardless of serostatus. This suggests that treatment should not differ when considering these treatments.

Cited by 45 publications

References 21 publications

Efficacy and Safety of Mycophenolate Mofetil Therapy in Neuromyelitis Optica Spectrum Disorders: A Systematic Review and Meta-Analysis

Efficacy and Safety of Mycophenolate Mofetil Therapy in Neuromyelitis Optica Spectrum Disorders: A Systematic Review and Meta-Analysis

Current immunotherapies for multiple sclerosis and neuromyelitis optica spectrum disorders: the similarities and differences

Epidemiology of neuromyelitis optica spectrum disorder in Denmark (1998–2008, 2007–2014)

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