Advertisement

Therapeutic strategies in NMOSD and MOGAD patients: A multicenter cohort study in Latin America

Published:January 11, 2023DOI:https://doi.org/10.1016/j.msard.2023.104508

      Abstract

      Purpose

      This study describes the therapeutic strategies in NMOSD and MOGAD adopted by neurologists to treat both conditions in Latin America (LATAM) with main focus on rituximab (RTX) and the disease outcome.

      Methods

      retrospective study in a cohort of NMOSD and MOGAD patients followed in specialized MS/NMOSD centers from eight countries and 14 LATAM reference centers. Demographics and clinical characteristics were collected. RTX strategies on naïve (for rituximab) patients were summarized as follows: scheme A: two 1000 mg infusions 15 days apart and repeated every 6 months; scheme B: four 375 mg/m2 infusions every week for 4 weeks and repeated every 6 months; scheme C: one 1000 mg infusions and repeated every 6 months; scheme D: other scheme used. Relapse rate and adverse events during follow-up were analyzed considering the different RTX schemes. Poisson and logistic regression analysis were used to assess baseline aspects and disease activity during follow-up.

      Results

      A total of 217 patients were included. 197 were NMOSD patients (164, 83.2% AQP4-IgG seropositive and 16.7% seronegative) and 20 were MOGAD patients. The most frequent long-term treatment was RTX in both groups (48.2% and 65% for NMOSD and MOGAD patients, respectively). The most common RTX regimen used in 79 (83.1%) patients was two 1000 mg infusions 15 days apart and repeat every 6 months. Relapses under RTX treatment were observed in 21 (22.1%) patients. Relapses after RTX treatment were associated with higher EDSS (OR 1.75, 95%CI 1.44–2.34, p = 0.03) and higher ARR pre-RTX (OR = 2.17, 95% CI 1.72–3.12, p = 0.002) but not with RTX regimen (OR = 1.10, 95% CI 0.89–1.21, p = 0.60).

      Conclusion

      the most strategy used in LATAM was RTX with two 1000 mg infusions 15 days apart. Relapses during follow up were not associated with RTX regimen used.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Multiple Sclerosis and Related Disorders
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

      1. Barreras, P., Vasileiou, E.S., Filippatou, A.G., Fitzgerald, K.C., Levy, M., Pardo, C.A., Newsome, S.D., Mowry, E.M., Calabresi, P.A., Sotirchos, E.S., 2022. Long-term effectiveness and safety of rituximab in neuromyelitis optica spectrum disorder and MOG antibody disease. 10.1212/WNL.0000000000201260.

        • Bedoya G.
        • Montoya P.
        • Garcia J.
        • Soto I.
        • Bourgeois S.
        • Carvajal L.
        • Labuda D.
        • Alvarez V.
        • Ospina J.
        • Hedrick P.W.
        • Ruiz-Linares A.
        Admixture dynamics in Hispanics: a shift in the nuclear genetic ancestry of a South American population isolate.
        Proc. Natl. Acad. Sci. U. S. A. 2006; 103: 7234-7239
        • Carnero Contentti E.
        • Correale J.
        Neuromyelitis optica spectrum disorders: from pathophysiology to therapeutic strategies.
        J. Neuroinflamm. 2021; 18: 208https://doi.org/10.1186/s12974-021-02249-1
        • Carnero Contentti E.
        • Daccach Marques V.
        • Soto de Castillo I.
        • Tkachuk V.
        • Ariel B.
        • Castillo M.C.
        • Cristiano E.
        • Diegues Serva G.B.
        • Dos Santos A.C.
        • Finkelsteyn A.M.
        • Lopez P.A.
        • Patrucco L.
        • Molina O.
        • Pettinicchi J.P.
        • Toneguzzo V.
        • Caride A.
        • Rojas J.I.
        Clinical features and prognosis of late-onset neuromyelitis optica spectrum disorders in a Latin American cohort.
        J. Neurol. 2020; 267: 1260-1268
        • Carnero Contentti E.
        • Rojas J.I.
        • Cristiano E.
        • Daccach Marques V.
        • Flores-Rivera J.
        • Lana-Peixoto M.
        • Carlos N.
        • Papais-Alvarenga R.
        • Sato D.K.
        • Soto de Castillo I.
        • Correale J.
        Latin American consensus recommendations for management and treatment of neuromyelitis optica spectrum disorders in clinical practice[Mult Scler Relat Disord. 2020 Oct;45:102428].
        Mult. Scler. Relat. Disord. 2021; 52103026
        • Correa-Diaz E.P.
        • Torres-Herran G.E.
        • Mino Zambrano J.E.
        • Paredes-Gonzalez V.
        • Caiza-Zambrano F.J.
        Impact of Rituximab on relapse rate and disability in an Ecuadorian cohort of patients with neuromyelitis optica spectrum disorders.
        Mult. Scler. Relat. Disord. 2021; 48102683
        • Jarius S.
        • Paul F.
        • Aktas O.
        • Asgari N.
        • Dale R.C.
        • de Seze J.
        • Franciotta D.
        • Fujihara K.
        • Jacob A.
        • Kim H.J.
        • Kleiter I.
        • Kumpfel T.
        • Levy M.
        • Palace J.
        • Ruprecht K.
        • Saiz A.
        • Trebst C.
        • Weinshenker B.G.
        • Wildemann B.
        [MOG encephalomyelitis: international recommendations on diagnosis and antibody testing].
        Nervenarzt. 2018; 89: 1388-1399
        • Jurynczyk M.
        • Jacob A.
        • Fujihara K.
        • Palace J.
        Myelin oligodendrocyte glycoprotein (MOG) antibody-associated disease: practical considerations.
        Pract. Neurol. 2019; 19: 187-195
        • Lennon V.A.
        • Wingerchuk D.M.
        • Kryzer T.J.
        • Pittock S.J.
        • Lucchinetti C.F.
        • Fujihara K.
        • Nakashima I.
        • Weinshenker B.G.
        A serum autoantibody marker of neuromyelitis optica: distinction from multiple sclerosis.
        Lancet. 2004; 364: 2106-2112
        • Novi G.
        • Bovis F.
        • Capobianco M.
        • Frau J.
        • Mataluni G.
        • Curti E.
        • Zuliani L.
        • Cavalla P.
        • Brambilla L.
        • Annovazzi P.
        • Repice A.M.
        • Lanzillo R.
        • Esposito S.
        • Benedetti L.
        • Maietta I.
        • Sica F.
        • Buttari F.
        • Malucchi S.
        • Fenu G.
        • Landi D.
        • Bosa C.
        • Realmuto S.
        • Malentacchi M.
        • Granella F.
        • Signori A.
        • Bonavita S.
        • Uccelli A.
        • Sormani M.P.
        Efficacy of different rituximab therapeutic strategies in patients with neuromyelitis optica spectrum disorders.
        Mult. Scler. Relat. Disord. 2019; 36101430
        • Poupart J.
        • Giovannelli J.
        • Deschamps R.
        • Audoin B.
        • Ciron J.
        • Maillart E.
        • Papeix C.
        • Collongues N.
        • Bourre B.
        • Cohen M.
        • Wiertlewski S.
        • Outteryck O.
        • Laplaud D.
        • Vukusic S.
        • Marignier R.
        • Zephir H.
        • group N.s.
        Evaluation of efficacy and tolerability of first-line therapies in NMOSD.
        Neurology. 2020; 94: e1645-e1656
        • Rivera V.M.
        • Hamuy F.
        • Rivas V.
        • Gracia F.
        • Rojas J.I.
        • Bichuetti D.B.
        • Villa A.M.
        • Marques V.D.
        • Soto A.
        • Bertado B.
        • Frenk I.T.
        • Galleguillos L.
        • Quinones J.
        • Ramirez D.A.
        • Caparo-Zamalloa C.
        • Ciampi E.
        • Lana-Peixoto M.A.
        • Rodriguez E.
        • Zarco L.
        • Sinay V.
        • Armas E.
        • Becker J.
        • Benzadon A.
        • Lopez E.
        • Carnero Contentti E.
        • Correa-Diaz E.P.
        • Diaz A.
        • Fleitas C.V.
        • Playas G.
        • Molina O.
        • Rojas E.
        • Sato D.
        • Soto I.
        • Cespedes J.V.
        • Correale J.
        • Barboza A.
        • Monterrey P.
        • Candelario A.
        • Tavolini D.R.
        • Parajeles A.
        • Pujol B.S.
        • Diaz de la Fe A.
        • Alonso R.
        • Bolana C.
        • Guzman M.K.
        • Carra A.
        • Gamarra O.G.
        • Raggio J.V.
        • Rodriguez L.C.
        • Ramirez N.E.
        • Ordonez L.
        • Skromne E.
        • Portillo L.L.
        • Canabal A.P.
        • Weiser R.
        • Sirias V.
        • Calderon R.F.
        • Cornejo E.A.
        • Hernandez M.
        • Quiroz J.C.D.
        • Garcia L.A.
        • Cedeno C.O.
        • Martinez J.
        • Abad-Herrera P.
        Status of the neuromyelitis optica spectrum disorder in Latin America.
        Mult. Scler. Relat. Disord. 2021; 53103083
        • Rojas J.I.
        • Gracia F.
        • Patrucco L.
        • Alonso R.
        • Carnero Contentti E.
        • Cristiano E.
        Multiple sclerosis and neuromyelitis optica spectrum disorder testing and treatment availability in Latin America.
        Neurol. Res. 2021; 43: 1081-1086
        • Shi M.
        • Chu F.
        • Jin T.
        • Zhu J.
        Progress in treatment of neuromyelitis optica spectrum disorders (NMOSD): novel insights into therapeutic possibilities in NMOSD.
        CNS Neurosci. Ther. 2022; 28: 981-991
        • Trebst C.
        • Jarius S.
        • Berthele A.
        • Paul F.
        • Schippling S.
        • Wildemann B.
        • Borisow N.
        • Kleiter I.
        • Aktas O.
        • Kumpfel T.
        • Neuromyelitis Optica Study G.
        Update on the diagnosis and treatment of neuromyelitis optica: recommendations of the Neuromyelitis Optica Study Group (NEMOS).
        J. Neurol. 2014; 261: 1-16
        • Waters P.
        • Woodhall M.
        • O'Connor K.C.
        • Reindl M.
        • Lang B.
        • Sato D.K.
        • Jurynczyk M.
        • Tackley G.
        • Rocha J.
        • Takahashi T.
        • Misu T.
        • Nakashima I.
        • Palace J.
        • Fujihara K.
        • Leite M.I.
        • Vincent A.
        MOG cell-based assay detects non-MS patients with inflammatory neurologic disease.
        Neurol. Neuroimmunol. Neuroinflamm. 2015; 2: e89
        • Waters P.J.
        • McKeon A.
        • Leite M.I.
        • Rajasekharan S.
        • Lennon V.A.
        • Villalobos A.
        • Palace J.
        • Mandrekar J.N.
        • Vincent A.
        • Bar-Or A.
        • Pittock S.J.
        Serologic diagnosis of NMO: a multicenter comparison of aquaporin-4-IgG assays.
        Neurology. 2012; 78 (discussion 669): 665-671
        • Wingerchuk D.M.
        • Banwell B.
        • Bennett J.L.
        • Cabre P.
        • Carroll W.
        • Chitnis T.
        • de Seze J.
        • Fujihara K.
        • Greenberg B.
        • Jacob A.
        • Jarius S.
        • Lana-Peixoto M.
        • Levy M.
        • Simon J.H.
        • Tenembaum S.
        • Traboulsee A.L.
        • Waters P.
        • Wellik K.E.
        • Weinshenker B.G.
        • International Panel for, N.M.O.D.
        International consensus diagnostic criteria for neuromyelitis optica spectrum disorders.
        Neurology. 2015; 85: 177-189