TY - JOUR
T1 - Clinical and therapeutic predictors of disease outcomes in AQP4-IgG+ neuromyelitis optica spectrum disorder
AU - Kunchok, Amy
AU - Malpas, Charles
AU - Nytrova, Petra
AU - Havrdova, Eva Kubala
AU - Alroughani, Raed
AU - Terzi, Murat
AU - Yamout, Bassem
AU - Hor, Jyh Yung
AU - Karabudak, Rana
AU - Boz, Cavit
AU - Ozakbas, Serkan
AU - Olascoaga, Javier
AU - Simo, Magdolna
AU - Granella, Franco
AU - Patti, Francesco
AU - McCombe, Pamela
AU - Csepany, Tunde
AU - Singhal, Bhim
AU - Bergamaschi, Roberto
AU - Fragoso, Yara
AU - Al-Harbi, Talal
AU - Turkoglu, Recai
AU - Lechner-Scott, Jeannette
AU - Laureys, Guy
AU - Oreja-Guevara, Celia
AU - Pucci, Eugenio
AU - Sola, Patrizia
AU - Ferraro, Diana
AU - Altintas, Ayse
AU - Soysal, Aysun
AU - Vucic, Steve
AU - Grand'Maison, Francois
AU - Izquierdo, Guillermo
AU - Eichau, Sara
AU - Lugaresi, Alessandra
AU - Onofrj, Marco
AU - Trojano, Maria
AU - Marriott, Mark
AU - Butzkueven, Helmut
AU - Kister, Ilya
AU - Kalincik, Tomas
PY - 2020/2/1
Y1 - 2020/2/1
N2 - 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.
AB - 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.
KW - Disability
KW - Immunosuppression
KW - Neuromyelitis optica spectrum disorder
KW - Predictors
KW - Relapses
KW - Therapy
UR - http://www.scopus.com/inward/record.url?scp=85076695270&partnerID=8YFLogxK
U2 - 10.1016/j.msard.2019.101868
DO - 10.1016/j.msard.2019.101868
M3 - Article
AN - SCOPUS:85076695270
SN - 2211-0348
VL - 38
JO - Multiple Sclerosis and Related Disorders
JF - Multiple Sclerosis and Related Disorders
M1 - 101868
ER -