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OUTCOMES OF PROPHYLACTIC TREATMENT IN PATIENTS WITH NEUROMYELITIS OPTICA SPECTRUM DISORDER
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Abstract
Objective: To evaluate the outcomes of preventive treatment in patients with Neuromyelitis Optica Spectrum Disorder (NMOSD). Methods: A retrospective descriptive study was conducted on 43 patients diagnosed with NMOSD according to the 2015 International Panel for NMO Diagnosis (IPND) criteria. All patients were treated at the Department of Neurology, Military Central Hospital 108. Results: The disease predominantly affected females (93.4%), with a mean age of onset of 44.2±13.9 years and an average disease duration of 24.19±43.55 months. Aquaporin-4 (AQP4) antibody positivity was observed in 83.7% of patients. NMOSD exhibited a high relapse rate, with 65.8% relapsing within the first year and 89.5% within five years of disease onset. Overall, preventive treatment reduced the relapse rate by 65.9%. Rituximab (RTX) led to an 82.4% reduction in relapses, with 58.3% achieving complete remission and a low treatment failure rate of 16.7%. Both Azathioprine (AZA) and Mycophenolate mofetil (MMF) reduced relapses by 58.8% and 42.4% respectively, but demonstrated high treatment failure rates (41.2% and 46.2%). Notably, MMF was the best-tolerated medication. Conclusion: Classical immunosuppressive therapies show considerable efficacy in preventing relapses in NMOSD patients. RTX appears to be more effective in reducing relapse rates, while MMF is the most tolerable and AZA is the most accessible for initial treatment.
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Keywords
Neuromyelitis optica spectrum disorder, relapse, annual relapse rate, immunosuppressive drugs
References
2. Carnero Contentti, E. and J. Correale, Neuromyelitis optica spectrum disorders: from pathophysiology to therapeutic strategies. J Neuroinflammation, 2021. 18(1): p. 208.
3. Ghezzi, A., R. Bergamaschi, V. Martinelli, et al., Clinical characteristics, course and prognosis of relapsing Devic's Neuromyelitis Optica. J Neurol, 2004. 251(1): p. 47-52.
4. Akaishi, T., T. Takahashi, T. Misu, et al., Progressive patterns of neurological disability in multiple sclerosis and neuromyelitis optica spectrum disorders. Sci Rep, 2020. 10(1): p. 13890.
5. Kumpfel, T., K. Giglhuber, O. Aktas, et al., Update on the diagnosis and treatment of neuromyelitis optica spectrum disorders (NMOSD) - revised recommendations of the Neuromyelitis Optica Study Group (NEMOS). Part II: Attack therapy and long-term management. J Neurol, 2024. 271(1): p. 141-176.
6. Nguyễn Văn Tuận và Nguyễn Văn Sỹ, Đặc điểm lâm sàng của phổ bệnh viêm tủy thị thần kinh. Tạp chí Y học Việt Nam, 2022. 520 - Số 1A - tháng 11: p. 231 - 236.
7. Zhang, W., L. Cui, Y. Zhang, et al., Questioning the existence of monophasic neuromyelitis optica spectrum disorder by defining a novel long-term relapse-free form from a large Chinese population. J Neurol, 2020. 267(4): p. 1197-1205.
8. Liu, C., M. Shi, M. Zhu, et al., Comparisons of clinical phenotype, radiological and laboratory features, and therapy of neuromyelitis optica spectrum disorder by regions: update and challenges. Autoimmun Rev, 2022. 21(1): p. 102921.
9. Mealy, M.A., D.M. Wingerchuk, J. Palace, et al., Comparison of relapse and treatment failure rates among patients with neuromyelitis optica: multicenter study of treatment efficacy. JAMA Neurol, 2014. 71(3): p. 324-30.
10. Huang, W., L. Wang, B. Zhang, et al., Effectiveness and tolerability of immunosuppressants and monoclonal antibodies in preventive treatment of neuromyelitis optica spectrum disorders: A systematic review and network meta-analysis. Mult Scler Relat Disord, 2019. 35: p. 246-252.