Highlights
- •Two-third of NMOSD in Arabian Gulf were seropositive.
- •Females were predominant regardless of disease serostatus.
- •Optic neuritis was founded to the commonest initial presentation.
- •Transverse myelitis contributed the most to hospitalization.
- •DMTs used in this cohort showed remission in most patients.
Abstract
Objective
To describe the clinical and radiological characteristics of neuromyelitis optica
spectrum disorders (NMOSD) patients from the Arabian Gulf relative to anti-aquaporin
4 antibody serostatus.
Methods
Retrospective multicentre study of hospital records of patients diagnosed with NMOSD
based on 2015 International Panel on NMOSD Diagnosis (IPND) consensus criteria.
Results
One hundred forty four patients were evaluated, 64.3% were anti-AQP4 antibody positive.
Mean age at onset and disease duration were 31±12 and 7 ± 6 years respectively. Patients
were predominantly female (4.7:1). Overall; relapsing course (80%) was more common
than monophasic (20%). Optic neuritis was the most frequent presentation (48.6%),
regardless of serostatus. The proportion of patients (54.3%) with visual acuity of
≤ 0.1 was higher in the seropositive group (p = 0.018). Primary presenting symptoms of transverse myelitis (TM) were observed in
29% of patients, and were the most significant correlate of hospitalization (p<0.001). Relative to anti-APQ4 serostatus, there were no significant differences in
terms of age of onset, course, relapse rates or efficacy outcomes except for oligoclonal
bands (OCB), which were more often present in seronegative patients (40% vs.22.5%;
p = 0.054). Irrespective of serostatus, several disease modifying therapies were instituted
including steroids or immunosuppressives, mostly, rituximab and azathioprine in the
cohort irrespective of serostatus. The use of rituximab resulted in reduction in disease
activity.
Conclusion
This is the first descriptive NMOSD cohort in the Arabian Gulf region. Seropositive
patients were more prevalent with female predominance. Relapsing course was more common
than monophasic. However, anti-AQP4 serostatus did not impact disease duration, relapse
rate or therapeutic effectiveness. These findings offer new insights into natural
history of NMOSD in patients of the Arabian Gulf and allow comparison with patient
populations in different World regions.
Keywords
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Article info
Publication history
Published online: October 19, 2019
Accepted:
October 13,
2019
Received in revised form:
October 1,
2019
Received:
June 13,
2019
Identification
Copyright
© 2019 Elsevier B.V. All rights reserved.
