Efficacy and tolerability of azathioprine for neuromyelitis optica spectrum disorder: A systematic review and meta-analysis

Espiritu, Adrian I.; Pasco, Paul Matthew D.

doi:10.1016/j.msard.2019.05.011

Cited by 51 publications

(40 citation statements)

References 29 publications

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“…Nevertheless, these ndings suggested that MMF exerted positive effects in preventing future relapses and considerably decreasing disability measured by EDSS. The e cacy of MMF was comparable to that of AZA but with less ADRs [25,14,16,15,26,18]. In addition, MMF has been substituted when treatment with AZA showed suboptimal responses or patients cannot tolerate the side effects of AZA.…”

Section: Discussionmentioning

confidence: 99%

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: Discussionmentioning

confidence: 99%

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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“…Rituximab can bind to CD20 epitopes expressed by prep and mature B cells to cause the destruction of B cells (35). It was reported that rituximab has acceptable tolerance, reduces the relapse frequency, and improves disability in most patients with NMOSD (36,37). The target of inebilizumab is the CD19 epitope also expressed by B cells.…”

Section: Discussionmentioning

confidence: 99%

“…To our best knowledge, this is the first meta-analysis carried out for comparing different kinds of monoclonal antibodies, using evidences completely based on RCTs. Previous metaanalyses were focused on rituximab and mainly based on retrospective studies (36,37,61,62). These meta-analyses pooled the data from uncontrolled trials with a heterogeneous dataset which were flawed with the inevitable existence of deviations.…”

Section: Discussionmentioning

confidence: 99%

Different Targets of Monoclonal Antibodies in Neuromyelitis Optica Spectrum Disorders: A Meta-Analysis Evidenced From Randomized Controlled Trials

Xue

Chen

et al. 2020

Front. Neurol.

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Background: Neuromyelitis optica spectrum disorder (NMOSD), an autoimmune inflammatory disorder of the central nervous system, often leads to vision loss or paralysis. This meta-analysis focused on the assessment of the monoclonal antibody therapy in NMOSD and compared different targets of monoclonal antibodies with each other in terms of efficacy and safety outcomes.Method: We searched through the databases of MEDLINE, EMBASE, Central Register of Controlled Trials (CENTRAL), and clinicaltrials.gov for randomized controlled trials (RCTs) evaluating monoclonal antibody therapy in NMOSD up to April 2020.Results: We identified seven randomized controlled trials (RCTs), including 775 patients (monoclonal antibody group, n = 485 and placebo group, n = 290). Monoclonal antibody therapy decreased relapse risk (RR 0.33, 95% CI 0.21–0.52, P < 0.00001), annualized relapse rate (ARR) (mean −0.28, 95% CI −0.35−0.20, P < 0.00001), expanded disability status scale score (EDSS) (mean −0.19, 95% CI −0.32−0.07, P = 0.002) and serious adverse events (RR 0.78, 95% CI 0.61–1.00, P = 0.05). However, we did not observe any significant difference in terms of adverse events or mortality. Further, the subgroup analysis demonstrated that the anti-complement protein C5 monoclonal antibody (eculizumab) might have a lower relapse risk (RR 0.07, 95% CI 0.02–0.23, P < 0.0001) in the AQP4 seropositive patients, and anti-interleukin-6 receptor monoclonal antibodies (satralizumab and tocilizumab) showed decreased EDSS score (mean −0.17, 95% CI −0.31−0.02, P = 0.02) more effectively than other monoclonal antibodies.Conclusions: Monoclonal antibodies were effective and safe in NMOSD. Different targets of monoclonal antibodies might have their own advantages.

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“…The efficacy of MMF was comparable to that of AZA but with fewer ADRs [17][18][19]21,31,32 . Besides, MMF therapy has been escalated when treatment with AZA showed a suboptimal response, or patients cannot tolerate AZA's side effects 25,27 .…”

Section: Discussionmentioning

confidence: 90%

Efficacy and safety of mycophenolate mofetil therapy in neuromyelitis optica spectrum disorders: a systematic review and meta-analysis

Songwisit

Kosiyakul

Jitprapaikulsan

et al. 2020

Sci Rep

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Mycophenolate mofetil (MMF) is an immunosuppressive agent (IS) which is widely prescribed in neuromyelitis optica spectrum disorder (NMOSD) patients. We aim to assess the efficacy and safety of MMF in controlling relapse and disease severity. Eligible studies obtained from the EMBASE and Ovid MEDLINE databases were 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. 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. A meta-analysis on ARR was conducted in 200 patients from 4 studies and on EDSS in 158 patients from 3 studies. The result showed a significant improvement with a mean reduction of 1.13 [95% confidence interval (CI) 0.60–1.65] in ARR, and a mean reduction of 0.85 (95% CI 0.36–1.34) in EDSS after MMF therapy. Adverse events occurred in 106 (17.8%) of 594 patients during MMF therapy. This systematic review and meta-analysis showed that using MMF as a preventive therapy in NMOSD patients can significantly reduce relapse rates and improve disease severity with acceptable tolerability.

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Efficacy and tolerability of azathioprine for neuromyelitis optica spectrum disorder: A systematic review and meta-analysis

Cited by 51 publications

References 29 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

Different Targets of Monoclonal Antibodies in Neuromyelitis Optica Spectrum Disorders: A Meta-Analysis Evidenced From Randomized Controlled Trials

Efficacy and safety of mycophenolate mofetil therapy in neuromyelitis optica spectrum disorders: a systematic review and meta-analysis

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