Long-term efficacy, tolerability and retention rate of azathioprine in 103 aquaporin-4 antibody-positive neuromyelitis optica spectrum disorder patients: a multicentre retrospective observational study from the UK
Background: Azathioprine (AZA) is a common immunosuppressive drug used for relapse prevention in neuromyelitis optica (NMO). Objectives: The objective of this paper is to assess efficacy, tolerability and retention of AZA in a large NMO cohort. Methods: We conducted a retrospective review of medical...
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| Veröffentlicht in: | Multiple sclerosis 2014-10, Vol.20 (11), p.1533-1540 |
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| creator | Elsone, Liene Kitley, Joanna Luppe, Sebastian Lythgoe, Daniel Mutch, Kerry Jacob, Saiju Brown, Rachel Moss, Kathryn McNeillis, Benjamin Goh, Yee Yen Leite, M Isabel Robertson, Neil Palace, Jackie Jacob, Anu |
| description | Background:
Azathioprine (AZA) is a common immunosuppressive drug used for relapse prevention in neuromyelitis optica (NMO).
Objectives:
The objective of this paper is to assess efficacy, tolerability and retention of AZA in a large NMO cohort.
Methods:
We conducted a retrospective review of medical records of 103 aquaporin-4 antibody-positive NMO and NMO spectrum disorder (NMOSD) patients treated with AZA.
Results:
This is the largest reported cohort of AQP4-Ab positive patients treated with AZA. Eighty-nine per cent (n = 92) had reduction in median annualised relapse rates from 1.5 (IQR 0.6–4.0) to 0 (IQR 0–0.27, p < 0.00005) with treatment. Sixty-one per cent (n = 63) remained relapse free at a median follow-up of 18 months. Neurological function improved or stabilised in 78%. At last follow-up, treatment was discontinued in 46% (n = 47). Of these, 62% (n = 29) were because of side effects, 19% (n = 9) because of death, 15% (n = 7) because of ongoing disease activity, and 2% (n = 1) because of pregnancy. Using Kaplan-Meyer curves, we estimate that 73%, 58%, 47% and 33% of patients will remain on AZA for longer than one, three, five and 10 years, respectively, after initiation of treatment.
Conclusions:
AZA is a modestly effective treatment for NMO. However, many patients discontinue AZA over time and this seems to reflect poor tolerability more than lack of efficacy. |
| doi_str_mv | 10.1177/1352458514525870 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1683348935</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sage_id>10.1177_1352458514525870</sage_id><sourcerecordid>1683348935</sourcerecordid><originalsourceid>FETCH-LOGICAL-c464t-f8a4b304990b53edf6b10ec1bbca44a2776d1f848bdca4c078d3911c733934763</originalsourceid><addsrcrecordid>eNp1kctu1TAQhiNERUthzwqNxIYFofaxHTvsUMVNHKkbuo58mbSukji1nUrhPXkfnJ6CUCVWtme--f_xTFW9ouQ9pVKeUSZ2XChBudgJJcmT6oRyKWvSSvK03Eu63vLH1fOUbgghUjLxrDre8YZLIeRJ9Wsfpqs6YxwB-95bbdd3kMOAURs_-LyCnhxEzDhlHyaIOiOEHvRPna99mKOfEPwElDDQt4ueQ4nUvFRlb4Jb6zkkn_0dwoRLDOOKRdQnCHMuZpBmtDkuIzifQnQYYdbZF6_0ATSMy1Co8oq4tRDDPb6JBZMw3umtJT1AyotboS_ykK8RLr-_qI56PSR8-XCeVpefP_04_1rvL758O_-4r20ZQK57pblhhLctMYKh6xtDCVpqjNWc652UjaO94sq4ErBEKsdaSq1krGVcNuy0envQnWO4XTDlbvTJ4jDoCcOSOtooxrhqmSjom0foTVhi6X6jqGQt50oVihwoWz6bIvZdmfCo49pR0m0r7x6vvJS8fhBezIjub8GfHRegPgBJX-E_rv8T_A0PALjm</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1617394488</pqid></control><display><type>article</type><title>Long-term efficacy, tolerability and retention rate of azathioprine in 103 aquaporin-4 antibody-positive neuromyelitis optica spectrum disorder patients: a multicentre retrospective observational study from the UK</title><source>SAGE Complete A-Z List</source><source>MEDLINE</source><creator>Elsone, Liene ; Kitley, Joanna ; Luppe, Sebastian ; Lythgoe, Daniel ; Mutch, Kerry ; Jacob, Saiju ; Brown, Rachel ; Moss, Kathryn ; McNeillis, Benjamin ; Goh, Yee Yen ; Leite, M Isabel ; Robertson, Neil ; Palace, Jackie ; Jacob, Anu</creator><creatorcontrib>Elsone, Liene ; Kitley, Joanna ; Luppe, Sebastian ; Lythgoe, Daniel ; Mutch, Kerry ; Jacob, Saiju ; Brown, Rachel ; Moss, Kathryn ; McNeillis, Benjamin ; Goh, Yee Yen ; Leite, M Isabel ; Robertson, Neil ; Palace, Jackie ; Jacob, Anu</creatorcontrib><description>Background:
Azathioprine (AZA) is a common immunosuppressive drug used for relapse prevention in neuromyelitis optica (NMO).
Objectives:
The objective of this paper is to assess efficacy, tolerability and retention of AZA in a large NMO cohort.
Methods:
We conducted a retrospective review of medical records of 103 aquaporin-4 antibody-positive NMO and NMO spectrum disorder (NMOSD) patients treated with AZA.
Results:
This is the largest reported cohort of AQP4-Ab positive patients treated with AZA. Eighty-nine per cent (n = 92) had reduction in median annualised relapse rates from 1.5 (IQR 0.6–4.0) to 0 (IQR 0–0.27, p < 0.00005) with treatment. Sixty-one per cent (n = 63) remained relapse free at a median follow-up of 18 months. Neurological function improved or stabilised in 78%. At last follow-up, treatment was discontinued in 46% (n = 47). Of these, 62% (n = 29) were because of side effects, 19% (n = 9) because of death, 15% (n = 7) because of ongoing disease activity, and 2% (n = 1) because of pregnancy. Using Kaplan-Meyer curves, we estimate that 73%, 58%, 47% and 33% of patients will remain on AZA for longer than one, three, five and 10 years, respectively, after initiation of treatment.
Conclusions:
AZA is a modestly effective treatment for NMO. However, many patients discontinue AZA over time and this seems to reflect poor tolerability more than lack of efficacy.</description><identifier>ISSN: 1352-4585</identifier><identifier>EISSN: 1477-0970</identifier><identifier>DOI: 10.1177/1352458514525870</identifier><identifier>PMID: 24647557</identifier><language>eng</language><publisher>London, England: SAGE Publications</publisher><subject>Adult ; Aged ; Aquaporin 4 - immunology ; Azathioprine - therapeutic use ; Female ; Humans ; Immunosuppressive Agents - therapeutic use ; Male ; Middle Aged ; Neuromyelitis Optica - drug therapy ; Neuromyelitis Optica - immunology ; Recurrence ; Retrospective Studies ; Time ; Treatment Outcome ; United Kingdom</subject><ispartof>Multiple sclerosis, 2014-10, Vol.20 (11), p.1533-1540</ispartof><rights>The Author(s) 2014</rights><rights>The Author(s) 2014.</rights><rights>SAGE Publications © Oct 2014</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c464t-f8a4b304990b53edf6b10ec1bbca44a2776d1f848bdca4c078d3911c733934763</citedby><cites>FETCH-LOGICAL-c464t-f8a4b304990b53edf6b10ec1bbca44a2776d1f848bdca4c078d3911c733934763</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://journals.sagepub.com/doi/pdf/10.1177/1352458514525870$$EPDF$$P50$$Gsage$$H</linktopdf><linktohtml>$$Uhttps://journals.sagepub.com/doi/10.1177/1352458514525870$$EHTML$$P50$$Gsage$$H</linktohtml><link.rule.ids>314,776,780,21798,27901,27902,43597,43598</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24647557$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Elsone, Liene</creatorcontrib><creatorcontrib>Kitley, Joanna</creatorcontrib><creatorcontrib>Luppe, Sebastian</creatorcontrib><creatorcontrib>Lythgoe, Daniel</creatorcontrib><creatorcontrib>Mutch, Kerry</creatorcontrib><creatorcontrib>Jacob, Saiju</creatorcontrib><creatorcontrib>Brown, Rachel</creatorcontrib><creatorcontrib>Moss, Kathryn</creatorcontrib><creatorcontrib>McNeillis, Benjamin</creatorcontrib><creatorcontrib>Goh, Yee Yen</creatorcontrib><creatorcontrib>Leite, M Isabel</creatorcontrib><creatorcontrib>Robertson, Neil</creatorcontrib><creatorcontrib>Palace, Jackie</creatorcontrib><creatorcontrib>Jacob, Anu</creatorcontrib><title>Long-term efficacy, tolerability and retention rate of azathioprine in 103 aquaporin-4 antibody-positive neuromyelitis optica spectrum disorder patients: a multicentre retrospective observational study from the UK</title><title>Multiple sclerosis</title><addtitle>Mult Scler</addtitle><description>Background:
Azathioprine (AZA) is a common immunosuppressive drug used for relapse prevention in neuromyelitis optica (NMO).
Objectives:
The objective of this paper is to assess efficacy, tolerability and retention of AZA in a large NMO cohort.
Methods:
We conducted a retrospective review of medical records of 103 aquaporin-4 antibody-positive NMO and NMO spectrum disorder (NMOSD) patients treated with AZA.
Results:
This is the largest reported cohort of AQP4-Ab positive patients treated with AZA. Eighty-nine per cent (n = 92) had reduction in median annualised relapse rates from 1.5 (IQR 0.6–4.0) to 0 (IQR 0–0.27, p < 0.00005) with treatment. Sixty-one per cent (n = 63) remained relapse free at a median follow-up of 18 months. Neurological function improved or stabilised in 78%. At last follow-up, treatment was discontinued in 46% (n = 47). Of these, 62% (n = 29) were because of side effects, 19% (n = 9) because of death, 15% (n = 7) because of ongoing disease activity, and 2% (n = 1) because of pregnancy. Using Kaplan-Meyer curves, we estimate that 73%, 58%, 47% and 33% of patients will remain on AZA for longer than one, three, five and 10 years, respectively, after initiation of treatment.
Conclusions:
AZA is a modestly effective treatment for NMO. However, many patients discontinue AZA over time and this seems to reflect poor tolerability more than lack of efficacy.</description><subject>Adult</subject><subject>Aged</subject><subject>Aquaporin 4 - immunology</subject><subject>Azathioprine - therapeutic use</subject><subject>Female</subject><subject>Humans</subject><subject>Immunosuppressive Agents - therapeutic use</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Neuromyelitis Optica - drug therapy</subject><subject>Neuromyelitis Optica - immunology</subject><subject>Recurrence</subject><subject>Retrospective Studies</subject><subject>Time</subject><subject>Treatment Outcome</subject><subject>United Kingdom</subject><issn>1352-4585</issn><issn>1477-0970</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNp1kctu1TAQhiNERUthzwqNxIYFofaxHTvsUMVNHKkbuo58mbSukji1nUrhPXkfnJ6CUCVWtme--f_xTFW9ouQ9pVKeUSZ2XChBudgJJcmT6oRyKWvSSvK03Eu63vLH1fOUbgghUjLxrDre8YZLIeRJ9Wsfpqs6YxwB-95bbdd3kMOAURs_-LyCnhxEzDhlHyaIOiOEHvRPna99mKOfEPwElDDQt4ueQ4nUvFRlb4Jb6zkkn_0dwoRLDOOKRdQnCHMuZpBmtDkuIzifQnQYYdbZF6_0ATSMy1Co8oq4tRDDPb6JBZMw3umtJT1AyotboS_ykK8RLr-_qI56PSR8-XCeVpefP_04_1rvL758O_-4r20ZQK57pblhhLctMYKh6xtDCVpqjNWc652UjaO94sq4ErBEKsdaSq1krGVcNuy0envQnWO4XTDlbvTJ4jDoCcOSOtooxrhqmSjom0foTVhi6X6jqGQt50oVihwoWz6bIvZdmfCo49pR0m0r7x6vvJS8fhBezIjub8GfHRegPgBJX-E_rv8T_A0PALjm</recordid><startdate>20141001</startdate><enddate>20141001</enddate><creator>Elsone, Liene</creator><creator>Kitley, Joanna</creator><creator>Luppe, Sebastian</creator><creator>Lythgoe, Daniel</creator><creator>Mutch, Kerry</creator><creator>Jacob, Saiju</creator><creator>Brown, Rachel</creator><creator>Moss, Kathryn</creator><creator>McNeillis, Benjamin</creator><creator>Goh, Yee Yen</creator><creator>Leite, M Isabel</creator><creator>Robertson, Neil</creator><creator>Palace, Jackie</creator><creator>Jacob, Anu</creator><general>SAGE Publications</general><general>Sage Publications Ltd</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>7T5</scope><scope>7TK</scope><scope>7U9</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9-</scope><scope>K9.</scope><scope>M0R</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7U7</scope><scope>C1K</scope></search><sort><creationdate>20141001</creationdate><title>Long-term efficacy, tolerability and retention rate of azathioprine in 103 aquaporin-4 antibody-positive neuromyelitis optica spectrum disorder patients: a multicentre retrospective observational study from the UK</title><author>Elsone, Liene ; Kitley, Joanna ; Luppe, Sebastian ; Lythgoe, Daniel ; Mutch, Kerry ; Jacob, Saiju ; Brown, Rachel ; Moss, Kathryn ; McNeillis, Benjamin ; Goh, Yee Yen ; Leite, M Isabel ; Robertson, Neil ; Palace, Jackie ; Jacob, Anu</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c464t-f8a4b304990b53edf6b10ec1bbca44a2776d1f848bdca4c078d3911c733934763</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aquaporin 4 - immunology</topic><topic>Azathioprine - therapeutic use</topic><topic>Female</topic><topic>Humans</topic><topic>Immunosuppressive Agents - therapeutic use</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Neuromyelitis Optica - drug therapy</topic><topic>Neuromyelitis Optica - immunology</topic><topic>Recurrence</topic><topic>Retrospective Studies</topic><topic>Time</topic><topic>Treatment Outcome</topic><topic>United Kingdom</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Elsone, Liene</creatorcontrib><creatorcontrib>Kitley, Joanna</creatorcontrib><creatorcontrib>Luppe, Sebastian</creatorcontrib><creatorcontrib>Lythgoe, Daniel</creatorcontrib><creatorcontrib>Mutch, Kerry</creatorcontrib><creatorcontrib>Jacob, Saiju</creatorcontrib><creatorcontrib>Brown, Rachel</creatorcontrib><creatorcontrib>Moss, Kathryn</creatorcontrib><creatorcontrib>McNeillis, Benjamin</creatorcontrib><creatorcontrib>Goh, Yee Yen</creatorcontrib><creatorcontrib>Leite, M Isabel</creatorcontrib><creatorcontrib>Robertson, Neil</creatorcontrib><creatorcontrib>Palace, Jackie</creatorcontrib><creatorcontrib>Jacob, Anu</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>Immunology Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</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 Essentials</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>AIDS and Cancer Research Abstracts</collection><collection>Consumer Health Database (Alumni Edition)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Consumer Health Database</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><collection>Toxicology Abstracts</collection><collection>Environmental Sciences and Pollution Management</collection><jtitle>Multiple sclerosis</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Elsone, Liene</au><au>Kitley, Joanna</au><au>Luppe, Sebastian</au><au>Lythgoe, Daniel</au><au>Mutch, Kerry</au><au>Jacob, Saiju</au><au>Brown, Rachel</au><au>Moss, Kathryn</au><au>McNeillis, Benjamin</au><au>Goh, Yee Yen</au><au>Leite, M Isabel</au><au>Robertson, Neil</au><au>Palace, Jackie</au><au>Jacob, Anu</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Long-term efficacy, tolerability and retention rate of azathioprine in 103 aquaporin-4 antibody-positive neuromyelitis optica spectrum disorder patients: a multicentre retrospective observational study from the UK</atitle><jtitle>Multiple sclerosis</jtitle><addtitle>Mult Scler</addtitle><date>2014-10-01</date><risdate>2014</risdate><volume>20</volume><issue>11</issue><spage>1533</spage><epage>1540</epage><pages>1533-1540</pages><issn>1352-4585</issn><eissn>1477-0970</eissn><abstract>Background:
Azathioprine (AZA) is a common immunosuppressive drug used for relapse prevention in neuromyelitis optica (NMO).
Objectives:
The objective of this paper is to assess efficacy, tolerability and retention of AZA in a large NMO cohort.
Methods:
We conducted a retrospective review of medical records of 103 aquaporin-4 antibody-positive NMO and NMO spectrum disorder (NMOSD) patients treated with AZA.
Results:
This is the largest reported cohort of AQP4-Ab positive patients treated with AZA. Eighty-nine per cent (n = 92) had reduction in median annualised relapse rates from 1.5 (IQR 0.6–4.0) to 0 (IQR 0–0.27, p < 0.00005) with treatment. Sixty-one per cent (n = 63) remained relapse free at a median follow-up of 18 months. Neurological function improved or stabilised in 78%. At last follow-up, treatment was discontinued in 46% (n = 47). Of these, 62% (n = 29) were because of side effects, 19% (n = 9) because of death, 15% (n = 7) because of ongoing disease activity, and 2% (n = 1) because of pregnancy. Using Kaplan-Meyer curves, we estimate that 73%, 58%, 47% and 33% of patients will remain on AZA for longer than one, three, five and 10 years, respectively, after initiation of treatment.
Conclusions:
AZA is a modestly effective treatment for NMO. However, many patients discontinue AZA over time and this seems to reflect poor tolerability more than lack of efficacy.</abstract><cop>London, England</cop><pub>SAGE Publications</pub><pmid>24647557</pmid><doi>10.1177/1352458514525870</doi><tpages>8</tpages></addata></record> |
| fulltext | fulltext |
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| ispartof | Multiple sclerosis, 2014-10, Vol.20 (11), p.1533-1540 |
| issn | 1352-4585 1477-0970 |
| language | eng |
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| source | SAGE Complete A-Z List; MEDLINE |
| subjects | Adult Aged Aquaporin 4 - immunology Azathioprine - therapeutic use Female Humans Immunosuppressive Agents - therapeutic use Male Middle Aged Neuromyelitis Optica - drug therapy Neuromyelitis Optica - immunology Recurrence Retrospective Studies Time Treatment Outcome United Kingdom |
| title | Long-term efficacy, tolerability and retention rate of azathioprine in 103 aquaporin-4 antibody-positive neuromyelitis optica spectrum disorder patients: a multicentre retrospective observational study from the UK |
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