Comparison of Relapse and Treatment Failure Rates Among Patients With Neuromyelitis Optica Multicenter Study of Treatment Efficacy

被引:222
作者
Mealy, Maureen A. [1 ]
Wingerchuk, Dean M. [2 ]
Palace, Jacqueline [3 ]
Greenberg, Benjamin M. [4 ]
Levy, Michael [1 ]
机构
[1] Johns Hopkins Univ, Dept Neurol, Baltimore, MD 21287 USA
[2] Mayo Clin, Dept Neurol, Scottsdale, AZ USA
[3] Oxford Univ Hosp NHS Trust, Dept Clin Neurol, Oxford, England
[4] Univ Texas Southwestern, Dept Neurol, Dallas, TX USA
关键词
SPECTRUM DISORDER; OPEN-LABEL; RITUXIMAB; AZATHIOPRINE; THERAPY;
D O I
10.1001/jamaneurol.2013.5699
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
IMPORTANCE Neuromyelitis optica (NMO) is an inflammatory disease of the optic nerves and spinal cord that leads to blindness and paralysis. Effective immunosuppression is the standard of care for relapse prevention. OBJECTIVE To compare the relapse and treatment failure rates among patients receiving the 3 most common forms of immunosuppression for NMO: azathioprine, mycophenolate mofetil, and rituximab. DESIGN, SETTING, AND PARTICIPANTS We performed a retrospective, multicenter analysis of relapses in 90 patients with NMO and NMO spectrum disorder treated with azathioprine, mycophenolate, and/or rituximab at the Mayo Clinic and the Johns Hopkins Hospital during the past 10 years. MAIN OUTCOME AND MEASURE Annualized relapse rates. RESULTS Rituximab reduced the relapse rate up to 88.2%, with 2 in 3 patients achieving complete remission. Mycophenolate reduced the relapse rate by up to 87.4%, with a 36% failure rate. Azathioprine reduced the relapse rate by 72.1% but had a 53% failure rate despite concurrent use of prednisone. CONCLUSIONS AND RELEVANCE Initial treatment with rituximab, mycophenolate, and, to a lesser degree, azathioprine significantly reduces relapse rates in NMO and NMO spectrum disorder patients. Patients for whom initial treatment fails often achieve remission when treatment is switched from one to another of these drugs.
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收藏
页码:324 / 330
页数:7
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