Journal article
Immunosuppressant and neuromyelitis optica spectrum disorder: Optimal treatment duration and risk of discontinuation
European Journal of Neurology, Vol.29(9), pp.2792-2800
2022
Abstract
Background and purpose
Preventing relapse by immunosuppressants (ISs) is critical for the prognosis of neuromyelitis optica spectrum disorder (NMOSD); however, the optimal duration of IS treatment is still under discussion. The objective was to explore the optimal duration of IS treatment and the risk of IS discontinuation for NMOSD.
Method
This cohort study was conducted at a major neurological center that housed the largest NMOSD database in South China. Eligible participants were patients with NMOSD undergoing IS treatment. The main outcome measures were changes in relapse risk based on IS treatment duration, clinical outcomes and predictors of relapse following IS discontinuation.
Results
In total, 343 patients were included in this study. The duration of IS treatment was strongly associated with a decrease in relapse risk (hazard ratio [HR] 0.53, p < 0.001). Continuous IS treatment resulted in decreased relapse HRs within 5 years of receiving IS medication, with a mild rebound starting at 5 years. Rituximab reduced the risk of NMOSD relapse to approximately zero within 3 years. The rate of relapse after IS withdrawal was high (77.5%). As opposed to other ISs, a delayed relapse following rituximab withdrawal was observed in this study. Longitudinal extensive transverse myelitis (HR = 2.023, p = 0.006) was associated with a higher risk of relapse after IS discontinuation.
Conclusions
Long-term IS medication for NMOSD is generally suitable. Patients with longitudinal extensive transverse myelitis had a higher risk of relapse after IS discontinuation. Future studies should explore individualized strategies of rituximab maintenance treatment.
Details
- Title
- Immunosuppressant and neuromyelitis optica spectrum disorder: Optimal treatment duration and risk of discontinuation
- Authors/Creators
- R. Li (Author/Creator) - Third Affiliated Hospital of Sun Yat-sen UniversityC. Li (Author/Creator) - Third Affiliated Hospital of Sun Yat-sen UniversityQ. Huang (Author/Creator) - The First People's Hospital of ZhaoqingZ. Liu (Author/Creator) - Third Affiliated Hospital of Sun Yat-sen UniversityJ. Chen (Author/Creator) - Third Affiliated Hospital of Sun Yat-sen UniversityB. Zhang (Author/Creator) - Third Affiliated Hospital of Sun Yat-sen UniversityC. Liu (Author/Creator) - Third Affiliated Hospital of Sun Yat-sen UniversityY. Shu (Author/Creator) - Third Affiliated Hospital of Sun Yat-sen UniversityY. Wang (Author/Creator) - Third Affiliated Hospital of Sun Yat-sen UniversityA.G. Kermode (Author/Creator) - Third Affiliated Hospital of Sun Yat-sen UniversityW. Qiu (Author/Creator) - Third Affiliated Hospital of Sun Yat-sen University
- Publication Details
- European Journal of Neurology, Vol.29(9), pp.2792-2800
- Publisher
- Wiley
- Identifiers
- 991005544411407891
- Copyright
- © 2022 European Academy of Neurology.
- Murdoch Affiliation
- Institute for Immunology and Infectious Diseases
- Language
- English
- Resource Type
- Journal article
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