Response to treatment in NMOSD: the Australasian experience.

Aquaporin 4 Humans Immunosuppressive Agents / therapeutic use Neuromyelitis Optica / drug therapy Retrospective Studies Rituximab / therapeutic use
Aquaporin Autoimmune disease Clinical features Multiple sclerosis Neuromyelitis optica

Journal

Multiple sclerosis and related disorders
ISSN: 2211-0356
Titre abrégé: Mult Scler Relat Disord
Pays: Netherlands
ID NLM: 101580247

Informations de publication

Date de publication:
Feb 2022
Historique:
received: 30 09 2021
revised: 09 11 2021
accepted: 14 11 2021
entrez: 26 2 2022
pubmed: 27 2 2022
medline: 3 3 2022
Statut: ppublish

Résumé

Neuromyelitis optica spectrum disorder (NMOSD) is associated with significant morbidity and mortality. Several therapies have been recommended for NMOSD and more recently clinical trials have demonstrated efficacy for three monoclonal antibody therapies. We present a retrospective observational study of treatment response in NMOSD. This was a retrospective, unblinded, observational study of treatment efficacy for rituximab and traditional immunosuppressive therapy in patients with AQP4 antibody positive NMOSD. Treatment efficacy was assessed using annualised relapse rates (ARR), time to first relapse and expanded disability status scale (EDSS) scores. Complete relapse and treatment data were available for 43/68 (63%) of AQP4 antibody positive NMOSD cases covering 74 episodes of treatment. In a time to first relapse analysis rituximab showed a risk ratio of 0.23 (95% CI 0.08 - 0.65) when compared with no treatment and there was a non-significant reduction in ARR of 35% compared to pre-treatment. β-interferon (p = 0.0002) and cyclophosphamide (p = 0.0034) were associated with an increased ARR compared to pre-treatment. Rituximab (median 4.0 [range 0.0 - 7.0]; p = 0.042) and traditional immunosuppressive therapy (median 4.0 [range 0.0 - 8.0]; p = 0.016) were associated with a lower final EDSS compared to β-interferon (median 6.0 [range 4.0 - 7.5]). These data provide additional support for the use of rituximab in preference to traditional immunosuppressive agents and MS disease modifying therapies as first line treatment of NMOSD.

Sections du résumé

BACKGROUND BACKGROUND
Neuromyelitis optica spectrum disorder (NMOSD) is associated with significant morbidity and mortality. Several therapies have been recommended for NMOSD and more recently clinical trials have demonstrated efficacy for three monoclonal antibody therapies. We present a retrospective observational study of treatment response in NMOSD.
METHODS METHODS
This was a retrospective, unblinded, observational study of treatment efficacy for rituximab and traditional immunosuppressive therapy in patients with AQP4 antibody positive NMOSD. Treatment efficacy was assessed using annualised relapse rates (ARR), time to first relapse and expanded disability status scale (EDSS) scores.
RESULTS RESULTS
Complete relapse and treatment data were available for 43/68 (63%) of AQP4 antibody positive NMOSD cases covering 74 episodes of treatment. In a time to first relapse analysis rituximab showed a risk ratio of 0.23 (95% CI 0.08 - 0.65) when compared with no treatment and there was a non-significant reduction in ARR of 35% compared to pre-treatment. β-interferon (p = 0.0002) and cyclophosphamide (p = 0.0034) were associated with an increased ARR compared to pre-treatment. Rituximab (median 4.0 [range 0.0 - 7.0]; p = 0.042) and traditional immunosuppressive therapy (median 4.0 [range 0.0 - 8.0]; p = 0.016) were associated with a lower final EDSS compared to β-interferon (median 6.0 [range 4.0 - 7.5]).
CONCLUSIONS CONCLUSIONS
These data provide additional support for the use of rituximab in preference to traditional immunosuppressive agents and MS disease modifying therapies as first line treatment of NMOSD.

Identifiants

DOI: 10.1016/j.msard.2021.103408 PMID: 35216788
pubmed: 35216788
pii: S2211-0348(21)00675-1
doi: 10.1016/j.msard.2021.103408
pii:
doi:

Substances chimiques

Aquaporin 4 0
Immunosuppressive Agents 0
Rituximab 4F4X42SYQ6

Types de publication

Journal Article Observational Study

Langues

eng

Sous-ensembles de citation

IM

Pagination

103408

Informations de copyright

Crown Copyright © 2021. Published by Elsevier B.V. All rights reserved.

Auteurs

Laura Clarke (L)

Menzies Health Institute Queensland, Gold Coast Campus, Griffith University QLD 4222, Australia; Department of Neurology Princess Alexandra Hospital, Woolloongabba QLD 4102, Australia.

Wajih Bukhari (W)

Menzies Health Institute Queensland, Gold Coast Campus, Griffith University QLD 4222, Australia; St Vincent's Hospital Melbourne, Fitzroy VIC 3065, AustraliA.

Cullen M O'Gorman (CM)

Menzies Health Institute Queensland, Gold Coast Campus, Griffith University QLD 4222, Australia; Department of Neurology Princess Alexandra Hospital, Woolloongabba QLD 4102, Australia; Department of Neurology, Mater Hospital Brisbane, South Brisbane QLD, 4101, Australia.

Elham Khalilidehkordi (E)

Menzies Health Institute Queensland, Gold Coast Campus, Griffith University QLD 4222, Australia; Department of Neurology, Royal Brisbane and Women's Hospital, Herston QLD 4029, Australia.

Simon Arnett (S)

Menzies Health Institute Queensland, Gold Coast Campus, Griffith University QLD 4222, Australia; Department of Neurology, Gold Coast University Hospital, Southport QLD 4215, Australia.

Mark Woodhall (M)

Nuffield Department of Clinical Neurosciences, John Radcliffe Infirmary, University of Oxford, Oxford OX3 9DU, UK.

Kerri M Prain (KM)

Department of Immunology, Pathology Queensland, Royal Brisbane and Women's Hospital, Herston QLD 4006, Australia.

John D E Parratt (JDE)

Sydney Medical School, Royal Prince Alfred Hospital, University of Sydney, Camperdown NSW 2006, Australia.

Michael H Barnett (MH)

Brain and Mind Research Institute, University of Sydney, Camperdown NSW 2006, Australia.

Mark P Marriott (MP)

Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Parkville VIC 3052, Australia.

Pamela A McCombe (PA)

Department of Neurology, Royal Brisbane and Women's Hospital, Herston QLD 4029, Australia; Centre for Clinical Research, Royal Brisbane and Women's Hospital, University of Queensland, Herston QLD 4029, AustraliA.

Ian Sutton (I)

Department of Neurology, St Vincent's Hospital, Darlinghurst NSW 2010, Australia.

Mike Boggild (M)

Department of Neurology, Townsville Hospital, Douglas QLD 4814, Australia.

Wallace Brownlee (W)

Department of Neurology, Auckland City Hospital, Grafton 1023, New Zealand; Institute of Neurology, University College London, Queen Square, London WC1N 3BG, UK.

William M Carroll (WM)

Centre for Neuromuscular and Neurological Disorders, Perron Institute for Neurological and Translational Science, Queen Elizabeth II Medical Centre, University of Western Australia, Nedlands WA 6009, AustraliA.

Suzanne Hodgkinson (S)

South Western Sydney Medical School, Liverpool Hospital, University of New South Wales, Liverpool NSW 2170, Australia.

Richard A L Macdonell (RAL)

Department of Neurology, Austin Health, Heidelberg VIC 3084, Australia.

Deborah F Mason (DF)

Department of Neurology, Christchurch Hospital, Christchurch 8140, New Zealand.

Jennifer Pereira (J)

Department of Neurology, Auckland City Hospital, Grafton 1023, New Zealand.

Mark Slee (M)

Flinders Medical Centre, Flinders University, Bedford Park SA 5042, Australia.

Chandi Das (C)

Department of Neurology, Canberra Hospital, Garran ACT 2605, Australia.

Andrew P D Henderson (APD)

Department of Neurology, Westmead Hospital, Westmead NSW 2145, Australia.

Allan G Kermode (AG)

Centre for Neuromuscular and Neurological Disorders, Perron Institute for Neurological and Translational Science, Queen Elizabeth II Medical Centre, University of Western Australia, Nedlands WA 6009, AustraliA; Institute for Immunology and Infectious Disease, Murdoch University, Murdoch WA 6150, AustraliA.

Jeannette Lechner-Scott (J)

Hunter Medical Research Institute, University of Newcastle, New Lambton Heights NSW 2305, AustralIA.

Patrick Waters (P)

Department of Neurology, Gold Coast University Hospital, Southport QLD 4215, Australia.

Jing Sun (J)

Menzies Health Institute Queensland, Gold Coast Campus, Griffith University QLD 4222, Australia.

Simon A Broadley (SA)

Menzies Health Institute Queensland, Gold Coast Campus, Griffith University QLD 4222, Australia; Department of Neurology, Gold Coast University Hospital, Southport QLD 4215, Australia. Electronic address: simon.broadley@griffith.edu.au.

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Classifications MeSH

questionsmedicales.fr › Acides aminés, peptides et protéines › Protéines › Protéines membranaires › Protéines de transport membranaire › Canaux ioniques › Porines › Aquaporines › Aquaporine-4 › Response to treatment in NMOSD: the...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Response to treatment in NMOSD: the...
questionsmedicales.fr › Actions chimiques et utilisations › Actions pharmacologiques › Effets physiologiques des médicaments › Facteurs immunologiques › Immunosuppresseurs › Response to treatment in NMOSD: the...
questionsmedicales.fr › Maladies du système immunitaire › Maladies auto-immunes › Maladies auto-immunes du système nerveux › Maladies démyélinisantes auto-immunes du SNC › Neuromyélite optique › Response to treatment in NMOSD: the...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études rétrospectives › Response to treatment in NMOSD: the...
questionsmedicales.fr › Acides aminés, peptides et protéines › Protéines › Globulines › Sérum-globulines › Immunoglobulines › Anticorps › Anticorps monoclonaux › Anticorps monoclonaux d'origine murine › Rituximab › Response to treatment in NMOSD: the...