Effects of immunotherapies and prognostic predictors in neuromyelitis optica spectrum disorder: a prospective cohort study
Background Neuromyelitis optica spectrum disorder (NMOSD), a relapsing autoimmune demyelinating disease of the CNS, often leads to severe visual and/or motor disability. This study aimed to evaluate the long-term effects of the first-line immunotherapies on relapse and disability, and identify the p...
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description | Background
Neuromyelitis optica spectrum disorder (NMOSD), a relapsing autoimmune demyelinating disease of the CNS, often leads to severe visual and/or motor disability. This study aimed to evaluate the long-term effects of the first-line immunotherapies on relapse and disability, and identify the prognostic predictors in NMOSD.
Methods
In this prospective cohort study, we enrolled patients with NMOSD from Southwest China and performed a long-term follow-up. We compared no immunotherapies (NIT) versus treatment of mycophenolate mofetil (MMF), azathioprine (AZA), or only corticosteroid (CS). Cox proportional-hazards model was used to explore the prognostic predictors in NMOSD.
Results
Ultimately, 281 patients were enrolled during 2009 to 2017. The proportions of relapse, motor disability, and mortality were significantly lower in treatments of MMF and AZA than in NIT (all
P
|
doi_str_mv | 10.1007/s00415-019-09649-7 |
format | Article |
fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_journals_2384698566</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2384698566</sourcerecordid><originalsourceid>FETCH-LOGICAL-c441t-b58ac6eb1df7ebb38cb6f495610f124eef9d27e7db1576e716c875cfed0127673</originalsourceid><addsrcrecordid>eNp9kMtOxSAQhonR6PHyAi4MiesqtFxad8Z4S0zc6Jq0MHg4saUCNTk-vRzrZecKwvzzzfAhdEzJGSVEnkdCGOUFoU1BGsGaQm6hBWVVWVDGm220IBUjBa8420P7Ma4IIXUu7KK9ikopZEkX6OPaWtApYm-x6_tp8GkJoR0dRNwOBo_Bvww-JqfzFYzTyYeI3YAHmILv1_DqksvdY060OI6ZFaYeGxd9MBAucLtBfL27d8DaL31IOKbJrA_Rjm1fIxx9nwfo-eb66equeHi8vb-6fCg0YzQVHa9bLaCjxkrouqrWnbCs4YISS0sGYBtTSpCmo1wKkFToWnJtwRBa5l9WB-h05uZF3iaISa38FIY8UpVVzURTcyFyqpxTOq8bA1g1Bte3Ya0oURvdatatsm71pVtt0Cff6Knrwfy2_PjNgWoOxFwaXiD8zf4H-wkUTo6p</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2384698566</pqid></control><display><type>article</type><title>Effects of immunotherapies and prognostic predictors in neuromyelitis optica spectrum disorder: a prospective cohort study</title><source>MEDLINE</source><source>Springer Nature - Complete Springer Journals</source><creator>Shi, Ziyan ; Du, Qin ; Chen, Hongxi ; Zhang, Ying ; Qiu, Yuhan ; Zhao, Zhengyang ; Wang, Jiancheng ; Yan, Chao ; Zhang, Qin ; Yang, Mu ; Zhou, Hongyu</creator><creatorcontrib>Shi, Ziyan ; Du, Qin ; Chen, Hongxi ; Zhang, Ying ; Qiu, Yuhan ; Zhao, Zhengyang ; Wang, Jiancheng ; Yan, Chao ; Zhang, Qin ; Yang, Mu ; Zhou, Hongyu</creatorcontrib><description>Background
Neuromyelitis optica spectrum disorder (NMOSD), a relapsing autoimmune demyelinating disease of the CNS, often leads to severe visual and/or motor disability. This study aimed to evaluate the long-term effects of the first-line immunotherapies on relapse and disability, and identify the prognostic predictors in NMOSD.
Methods
In this prospective cohort study, we enrolled patients with NMOSD from Southwest China and performed a long-term follow-up. We compared no immunotherapies (NIT) versus treatment of mycophenolate mofetil (MMF), azathioprine (AZA), or only corticosteroid (CS). Cox proportional-hazards model was used to explore the prognostic predictors in NMOSD.
Results
Ultimately, 281 patients were enrolled during 2009 to 2017. The proportions of relapse, motor disability, and mortality were significantly lower in treatments of MMF and AZA than in NIT (all
P
< 0.001), while no significant difference was found between the CS and NIT groups. The multivariate Cox analyses indicated that onset with optic neuritis and increased age at onset were risk predictors of visual disability and motor disability, respectively. Comparing with NIT, MMF and AZA were remarkably reduced risk of relapse and motor disability but not visual disability. Additionally, median time to first relapse and motor disability was significantly longer in treatments of MMF and AZA than in NIT (both
P
< 0.001). Furthermore, we estimated the risk of relapse and disability for AQP4-Abs positive NMOSD in 1–5 years based on prognostic predictors identified above.
Conclusions
Our study revealed the potential predictors of relapse and disability, and strengthened evidence that early immunosuppressive treatments, such as MMF and AZA, could effectively reduce the risk of relapse and disability, and delayed progression of NMOSD.</description><identifier>ISSN: 0340-5354</identifier><identifier>EISSN: 1432-1459</identifier><identifier>DOI: 10.1007/s00415-019-09649-7</identifier><identifier>PMID: 31776721</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Adrenal Cortex Hormones - administration & dosage ; Adrenal Cortex Hormones - pharmacology ; Aquaporin 4 ; Autoimmune diseases ; Azathioprine ; Azathioprine - administration & dosage ; Azathioprine - pharmacology ; Cohort analysis ; Corticosteroids ; Demyelinating diseases ; Demyelination ; Disabled Persons ; Follow-Up Studies ; Health risk assessment ; Humans ; Immunosuppressive Agents - administration & dosage ; Immunosuppressive Agents - pharmacology ; Immunotherapy ; Long-term effects ; Medicine ; Medicine & Public Health ; Mycophenolate mofetil ; Mycophenolic acid ; Mycophenolic Acid - administration & dosage ; Mycophenolic Acid - pharmacology ; Neuritis ; Neurology ; Neuromyelitis ; Neuromyelitis Optica - drug therapy ; Neuromyelitis Optica - physiopathology ; Neuroradiology ; Neurosciences ; Optic neuritis ; Original Communication ; Outcome Assessment, Health Care ; Prognosis ; Proportional Hazards Models ; Prospective Studies ; Risk Factors ; Secondary Prevention ; Sensorimotor integration</subject><ispartof>Journal of neurology, 2020-04, Vol.267 (4), p.913-924</ispartof><rights>Springer-Verlag GmbH Germany, part of Springer Nature 2019</rights><rights>Journal of Neurology is a copyright of Springer, (2019). All Rights Reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c441t-b58ac6eb1df7ebb38cb6f495610f124eef9d27e7db1576e716c875cfed0127673</citedby><cites>FETCH-LOGICAL-c441t-b58ac6eb1df7ebb38cb6f495610f124eef9d27e7db1576e716c875cfed0127673</cites><orcidid>0000-0001-6959-6947</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00415-019-09649-7$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00415-019-09649-7$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31776721$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Shi, Ziyan</creatorcontrib><creatorcontrib>Du, Qin</creatorcontrib><creatorcontrib>Chen, Hongxi</creatorcontrib><creatorcontrib>Zhang, Ying</creatorcontrib><creatorcontrib>Qiu, Yuhan</creatorcontrib><creatorcontrib>Zhao, Zhengyang</creatorcontrib><creatorcontrib>Wang, Jiancheng</creatorcontrib><creatorcontrib>Yan, Chao</creatorcontrib><creatorcontrib>Zhang, Qin</creatorcontrib><creatorcontrib>Yang, Mu</creatorcontrib><creatorcontrib>Zhou, Hongyu</creatorcontrib><title>Effects of immunotherapies and prognostic predictors in neuromyelitis optica spectrum disorder: a prospective cohort study</title><title>Journal of neurology</title><addtitle>J Neurol</addtitle><addtitle>J Neurol</addtitle><description>Background
Neuromyelitis optica spectrum disorder (NMOSD), a relapsing autoimmune demyelinating disease of the CNS, often leads to severe visual and/or motor disability. This study aimed to evaluate the long-term effects of the first-line immunotherapies on relapse and disability, and identify the prognostic predictors in NMOSD.
Methods
In this prospective cohort study, we enrolled patients with NMOSD from Southwest China and performed a long-term follow-up. We compared no immunotherapies (NIT) versus treatment of mycophenolate mofetil (MMF), azathioprine (AZA), or only corticosteroid (CS). Cox proportional-hazards model was used to explore the prognostic predictors in NMOSD.
Results
Ultimately, 281 patients were enrolled during 2009 to 2017. The proportions of relapse, motor disability, and mortality were significantly lower in treatments of MMF and AZA than in NIT (all
P
< 0.001), while no significant difference was found between the CS and NIT groups. The multivariate Cox analyses indicated that onset with optic neuritis and increased age at onset were risk predictors of visual disability and motor disability, respectively. Comparing with NIT, MMF and AZA were remarkably reduced risk of relapse and motor disability but not visual disability. Additionally, median time to first relapse and motor disability was significantly longer in treatments of MMF and AZA than in NIT (both
P
< 0.001). Furthermore, we estimated the risk of relapse and disability for AQP4-Abs positive NMOSD in 1–5 years based on prognostic predictors identified above.
Conclusions
Our study revealed the potential predictors of relapse and disability, and strengthened evidence that early immunosuppressive treatments, such as MMF and AZA, could effectively reduce the risk of relapse and disability, and delayed progression of NMOSD.</description><subject>Adrenal Cortex Hormones - administration & dosage</subject><subject>Adrenal Cortex Hormones - pharmacology</subject><subject>Aquaporin 4</subject><subject>Autoimmune diseases</subject><subject>Azathioprine</subject><subject>Azathioprine - administration & dosage</subject><subject>Azathioprine - pharmacology</subject><subject>Cohort analysis</subject><subject>Corticosteroids</subject><subject>Demyelinating diseases</subject><subject>Demyelination</subject><subject>Disabled Persons</subject><subject>Follow-Up Studies</subject><subject>Health risk assessment</subject><subject>Humans</subject><subject>Immunosuppressive Agents - administration & dosage</subject><subject>Immunosuppressive Agents - pharmacology</subject><subject>Immunotherapy</subject><subject>Long-term effects</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Mycophenolate mofetil</subject><subject>Mycophenolic acid</subject><subject>Mycophenolic Acid - administration & dosage</subject><subject>Mycophenolic Acid - pharmacology</subject><subject>Neuritis</subject><subject>Neurology</subject><subject>Neuromyelitis</subject><subject>Neuromyelitis Optica - drug therapy</subject><subject>Neuromyelitis Optica - physiopathology</subject><subject>Neuroradiology</subject><subject>Neurosciences</subject><subject>Optic neuritis</subject><subject>Original Communication</subject><subject>Outcome Assessment, Health Care</subject><subject>Prognosis</subject><subject>Proportional Hazards Models</subject><subject>Prospective Studies</subject><subject>Risk Factors</subject><subject>Secondary Prevention</subject><subject>Sensorimotor integration</subject><issn>0340-5354</issn><issn>1432-1459</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNp9kMtOxSAQhonR6PHyAi4MiesqtFxad8Z4S0zc6Jq0MHg4saUCNTk-vRzrZecKwvzzzfAhdEzJGSVEnkdCGOUFoU1BGsGaQm6hBWVVWVDGm220IBUjBa8420P7Ma4IIXUu7KK9ikopZEkX6OPaWtApYm-x6_tp8GkJoR0dRNwOBo_Bvww-JqfzFYzTyYeI3YAHmILv1_DqksvdY060OI6ZFaYeGxd9MBAucLtBfL27d8DaL31IOKbJrA_Rjm1fIxx9nwfo-eb66equeHi8vb-6fCg0YzQVHa9bLaCjxkrouqrWnbCs4YISS0sGYBtTSpCmo1wKkFToWnJtwRBa5l9WB-h05uZF3iaISa38FIY8UpVVzURTcyFyqpxTOq8bA1g1Bte3Ya0oURvdatatsm71pVtt0Cff6Knrwfy2_PjNgWoOxFwaXiD8zf4H-wkUTo6p</recordid><startdate>20200401</startdate><enddate>20200401</enddate><creator>Shi, Ziyan</creator><creator>Du, Qin</creator><creator>Chen, Hongxi</creator><creator>Zhang, Ying</creator><creator>Qiu, Yuhan</creator><creator>Zhao, Zhengyang</creator><creator>Wang, Jiancheng</creator><creator>Yan, Chao</creator><creator>Zhang, Qin</creator><creator>Yang, Mu</creator><creator>Zhou, Hongyu</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7TK</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><orcidid>https://orcid.org/0000-0001-6959-6947</orcidid></search><sort><creationdate>20200401</creationdate><title>Effects of immunotherapies and prognostic predictors in neuromyelitis optica spectrum disorder: a prospective cohort study</title><author>Shi, Ziyan ; Du, Qin ; Chen, Hongxi ; Zhang, Ying ; Qiu, Yuhan ; Zhao, Zhengyang ; Wang, Jiancheng ; Yan, Chao ; Zhang, Qin ; Yang, Mu ; Zhou, Hongyu</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c441t-b58ac6eb1df7ebb38cb6f495610f124eef9d27e7db1576e716c875cfed0127673</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Adrenal Cortex Hormones - administration & dosage</topic><topic>Adrenal Cortex Hormones - pharmacology</topic><topic>Aquaporin 4</topic><topic>Autoimmune diseases</topic><topic>Azathioprine</topic><topic>Azathioprine - administration & dosage</topic><topic>Azathioprine - pharmacology</topic><topic>Cohort analysis</topic><topic>Corticosteroids</topic><topic>Demyelinating diseases</topic><topic>Demyelination</topic><topic>Disabled Persons</topic><topic>Follow-Up Studies</topic><topic>Health risk assessment</topic><topic>Humans</topic><topic>Immunosuppressive Agents - administration & dosage</topic><topic>Immunosuppressive Agents - pharmacology</topic><topic>Immunotherapy</topic><topic>Long-term effects</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Mycophenolate mofetil</topic><topic>Mycophenolic acid</topic><topic>Mycophenolic Acid - administration & dosage</topic><topic>Mycophenolic Acid - pharmacology</topic><topic>Neuritis</topic><topic>Neurology</topic><topic>Neuromyelitis</topic><topic>Neuromyelitis Optica - drug therapy</topic><topic>Neuromyelitis Optica - physiopathology</topic><topic>Neuroradiology</topic><topic>Neurosciences</topic><topic>Optic neuritis</topic><topic>Original Communication</topic><topic>Outcome Assessment, Health Care</topic><topic>Prognosis</topic><topic>Proportional Hazards Models</topic><topic>Prospective Studies</topic><topic>Risk Factors</topic><topic>Secondary Prevention</topic><topic>Sensorimotor integration</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Shi, Ziyan</creatorcontrib><creatorcontrib>Du, Qin</creatorcontrib><creatorcontrib>Chen, Hongxi</creatorcontrib><creatorcontrib>Zhang, Ying</creatorcontrib><creatorcontrib>Qiu, Yuhan</creatorcontrib><creatorcontrib>Zhao, Zhengyang</creatorcontrib><creatorcontrib>Wang, Jiancheng</creatorcontrib><creatorcontrib>Yan, Chao</creatorcontrib><creatorcontrib>Zhang, Qin</creatorcontrib><creatorcontrib>Yang, Mu</creatorcontrib><creatorcontrib>Zhou, Hongyu</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Neurosciences Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><jtitle>Journal of neurology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Shi, Ziyan</au><au>Du, Qin</au><au>Chen, Hongxi</au><au>Zhang, Ying</au><au>Qiu, Yuhan</au><au>Zhao, Zhengyang</au><au>Wang, Jiancheng</au><au>Yan, Chao</au><au>Zhang, Qin</au><au>Yang, Mu</au><au>Zhou, Hongyu</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Effects of immunotherapies and prognostic predictors in neuromyelitis optica spectrum disorder: a prospective cohort study</atitle><jtitle>Journal of neurology</jtitle><stitle>J Neurol</stitle><addtitle>J Neurol</addtitle><date>2020-04-01</date><risdate>2020</risdate><volume>267</volume><issue>4</issue><spage>913</spage><epage>924</epage><pages>913-924</pages><issn>0340-5354</issn><eissn>1432-1459</eissn><abstract>Background
Neuromyelitis optica spectrum disorder (NMOSD), a relapsing autoimmune demyelinating disease of the CNS, often leads to severe visual and/or motor disability. This study aimed to evaluate the long-term effects of the first-line immunotherapies on relapse and disability, and identify the prognostic predictors in NMOSD.
Methods
In this prospective cohort study, we enrolled patients with NMOSD from Southwest China and performed a long-term follow-up. We compared no immunotherapies (NIT) versus treatment of mycophenolate mofetil (MMF), azathioprine (AZA), or only corticosteroid (CS). Cox proportional-hazards model was used to explore the prognostic predictors in NMOSD.
Results
Ultimately, 281 patients were enrolled during 2009 to 2017. The proportions of relapse, motor disability, and mortality were significantly lower in treatments of MMF and AZA than in NIT (all
P
< 0.001), while no significant difference was found between the CS and NIT groups. The multivariate Cox analyses indicated that onset with optic neuritis and increased age at onset were risk predictors of visual disability and motor disability, respectively. Comparing with NIT, MMF and AZA were remarkably reduced risk of relapse and motor disability but not visual disability. Additionally, median time to first relapse and motor disability was significantly longer in treatments of MMF and AZA than in NIT (both
P
< 0.001). Furthermore, we estimated the risk of relapse and disability for AQP4-Abs positive NMOSD in 1–5 years based on prognostic predictors identified above.
Conclusions
Our study revealed the potential predictors of relapse and disability, and strengthened evidence that early immunosuppressive treatments, such as MMF and AZA, could effectively reduce the risk of relapse and disability, and delayed progression of NMOSD.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>31776721</pmid><doi>10.1007/s00415-019-09649-7</doi><tpages>12</tpages><orcidid>https://orcid.org/0000-0001-6959-6947</orcidid></addata></record> |
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subjects | Adrenal Cortex Hormones - administration & dosage Adrenal Cortex Hormones - pharmacology Aquaporin 4 Autoimmune diseases Azathioprine Azathioprine - administration & dosage Azathioprine - pharmacology Cohort analysis Corticosteroids Demyelinating diseases Demyelination Disabled Persons Follow-Up Studies Health risk assessment Humans Immunosuppressive Agents - administration & dosage Immunosuppressive Agents - pharmacology Immunotherapy Long-term effects Medicine Medicine & Public Health Mycophenolate mofetil Mycophenolic acid Mycophenolic Acid - administration & dosage Mycophenolic Acid - pharmacology Neuritis Neurology Neuromyelitis Neuromyelitis Optica - drug therapy Neuromyelitis Optica - physiopathology Neuroradiology Neurosciences Optic neuritis Original Communication Outcome Assessment, Health Care Prognosis Proportional Hazards Models Prospective Studies Risk Factors Secondary Prevention Sensorimotor integration |
title | Effects of immunotherapies and prognostic predictors in neuromyelitis optica spectrum disorder: a prospective cohort study |
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