Abstract
Background
Aquaporin-4-IgG positive (AQP4-IgG+) Neuromyelitis Optica Spectrum Disorder (NMOSD)
is an uncommon central nervous system autoimmune disorder. Disease outcomes in AQP4-IgG+NMOSD
are typically measured by relapse rate and disability. Using the MSBase, a multi-centre
international registry, we aimed to examine the impact immunosuppressive therapies
and patient characteristics as predictors of disease outcome measures in AQP4-IgG+NMOSD.
Method
This MSBase cohort study of AQP4-IgG+NMOSD patients examined modifiers of relapse
in a multivariable proportional hazards model and expanded disability status score
(EDSS) using a mixed effects model.
Results
206 AQP4-IgG+ patients were included (median follow-up 3.7 years). Age (hazard ratio
[HR] = 0.82 per decade, p = 0.001), brainstem onset (HR = 0.45, p = 0.009), azathioprine (HR = 0.46, p<0.001) and mycophenolate mofetil (HR = 0.09, p = 0.012) were associated with a reduced risk of relapse. A greater EDSS was associated
with age (β = 0.45 (per decade), p<0.001) and disease duration (β = 0.07 per year, p<0.001). A slower increase in EDSS was associated with azathioprine (β = -0.48, p<0.001), mycophenolate mofetil (β = -0.69, p = 0.04) and rituximab (β = -0.35, p = 0.024).
Interpretation
This study has demonstrated that azathioprine and mycophenolate mofetil reduce the
risk of relapses and disability progression is modified by azathioprine, mycophenolate
mofetil and rituximab. Age and disease duration were the only patient characteristics
that modified the risk of relapse and disability in our cohort.
Keywords
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Article info
Publication history
Published online: November 25, 2019
Accepted:
November 23,
2019
Received in revised form:
November 22,
2019
Received:
October 3,
2019
Identification
Copyright
© 2019 Elsevier B.V. All rights reserved.
