Efficacy of azathioprine, mycophenolate mofetil, and rituximab in the treatment of neuromyelitis optica spectrum disorder and analysis of prognostic factors

Abstract

ObjectiveThe study aims to compare the efficacies of the immunosuppressants most commonly prescribed for patients with neuromyelitis optica spectrum disorder (NMOSD). The predictors, which might be associated with relapse and disability in NMOSD, were also analyzed. Methods This retrospective study included NMOSD patients treated with azathioprine (AZA), mycophenolate mofetil (MMF), and rituximab (RTX). The annual relapse rate (ARR) and the incidence rates of adverse events were compared. Cox proportional-hazards model calculated the potential predictors of NMOSD relapse and disability. Results A total of 83 patients were included. The median treatment time of AZA group (n = 34), MMF group (n = 20), and RTX group (n = 29) were 19.5, 15.5, and 12 months, respectively. ARR of the three groups reduced significantly after treatment. In the three groups, 55.9%, 50%, and 79.3% of patients, respectively, were free from relapse. However, the difference among the three groups was of no statistical significance, possibly due to the small sample size. During the treatment, 32.4%, 15%, and 24.1% of patients experienced adverse events in the AZA group, MMF group, and RTX group, respectively. Additionally, the multivariate Cox analyses indicated that history of a severe attack and disease duration were associated with the risk of relapse after immunotherapy. Late-onset (≥ 50 years old) NMOSD patients were probably more susceptible to motor disability, and those with optic neuritis at onset were more likely to develop visual disability. Conclusions AZA, MMF, and low-dose RTX were all effective in reducing the relapse rate in NMOSD. The age at onset, disease duration, history of severe attacks, and primary syndromes might be significant prognostic predictors in NMOSD.

A meta-analysis on efficacy and safety of rituximab for neuromyelitis optica spectrum disorders

“…Effects on ARR. A total of 26 studies [2,3,5,7,8,[10][11][12]17,[19][20][21][23][24][25][26][27][28][32][33][34][35][36][37][38][39] were reported ARR before and after RTX therapy in patients with NMOSD. The results of Meta-analysis showed that the ARR of NMOSD patients after RTX treatment was significantly decreased by 1.45, and the difference was statistically significant (WMD = 1.45, 95% CI: 1.24-1.66, P < .01).…”

Treatment access and satisfaction on disease-modifying therapies of neuromyelitis optica spectrum disorder patients in China: a cross-sectional survey

“… 37 MMF was favored over rituximab probably due to its convenience as an oral drug and the significant cost reduction; as compared to AZA, it is supposed that MMF was preferred for its slight advantage in observed safety in the Chinese patient population. 43 – 45 Drug supply may be another real-world factor influencing the choice of therapy by prescribers, which is beyond the scope of this study.…”

Efficacy and safety of mycophenolate mofetil for steroid reduction in neuromyelitis optica spectrum disorder: a prospective cohort study

“…Mycophenolate mofetil (MMF), as a non-steroidal immunosuppressive agent, has been reported to be effective for NMOSD, which may alleviate the adverse events associated with long-term administration of high-dose steroids. However, most studies have been retrospective [9][10][11][12][13][14][15][16][17][18][19][20]. Only a few studies have prospectively implemented steroid reduction protocols, and the participants were relatively young (in their 30s and 40s) [21,22].…”