Alexis Montcuquet1, Nicolas Collongues2, Caroline Papeix3, Helene Zephir4, Bertrand Audoin5, David Laplaud6, Bertrand Bourre7, Bruno Brochet8, Jean-Philippe Camdessanche9, Pierre Labauge10, Thibault Moreau11, David Brassat12, Bruno Stankoff13, Jerome de Seze14, Sandra Vukusic15, Romain Marignier15. 1. Service de Neurologie A and Eugène Devic EDMUS Foundation against Multiple Sclerosis, Observatoire Français de la Sclérose en Plaques (OFSEP), Hôpital Neurologique Pierre Wertheimer-GHE, Hospices Civils de Lyon, Bron, France/Department of Neurology, Hôpital Dupuytren, Limoges, France. 2. Department of Neurology, and INSERM CIC-1434, CHU de Strasbourg, Strasbourg, France. 3. Department of Neurology, Hôpital Pitié-Salpêtrière, Paris, France. 4. Clinique Neurologique, University of Lille, Lille, France. 5. Department of Neurology, Hôpital Timone, Marseille, France. 6. Department of Neurology, University Hospital of Nantes, Nantes, France. 7. Department of Neurology, University Hospital of Rouen, Rouen, France. 8. Department of Neurology, and INSERM-CHU CIC-P 0005, CHU de Bordeaux, Bordeaux, France. 9. Department of Neurology, University Hospital of Saint-Etienne, Saint-Etienne, France. 10. Department of Neurology, University Hospital of Montpellier, Montpellier, France. 11. Department of Neurology, University Hospital of Dijon, Dijon, France. 12. Department of Neurology, University Hospital of Purpan, Toulouse, France. 13. Department of Neurology, Hopital Tenon, Paris, France. 14. Department of Neurology and INSERM CIC-1434, CHU de Strasbourg, France. 15. Service de Neurologie A and Eugène Devic EDMUS Foundation against Multiple Sclerosis, Observatoire Français de la Sclérose en Plaques (OFSEP), Hôpital Neurologique Pierre Wertheimer-GHE, Hospices Civils de Lyon, Bron, France/Lyon's Neuroscience Research Center, Team ONCOFLAM, Inserm U 1028/CNRS 5292, Lyon, France Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France.
Abstract
OBJECTIVE: To evaluate the effectiveness and tolerance of mycophenolate mofetil (MMF) as a first-line treatment in neuromyelitis optica spectrum disorder (NMOSD). METHODS: In all, 67 NMOSD patients treated by MMF as first-line therapy, from the NOMADMUS cohort were included. A total of 65 fulfilled 2015 NMOSD criteria, and 5 were myelin oligodendrocyte glycoprotein (MOG)-immunoglobulin G (IgG) positive. Effectiveness was evaluated on percentage of patients continuing MMF, percentage of patients free of relapse, pre- and post-treatment change in the annualized relapse rate (ARR), and Expanded Disability Status Scale (EDSS). RESULTS: Among 67 patients, 40 (59.7%) continued treatment till last follow-up. A total of 33 (49.3%) were relapse-free. The median ARR decreased from one pre-treatment to zero post-treatment. Of 53 patients with complete EDSS data, the score improved or stabilized in 44 (83%; p < 0.05). Effectiveness was observed in aquaporin-4 (AQP4)-IgG (57.8% continued treatment, 46.7% relapse-free), MOG-IgG (3/5 continued treatment, 4/5 relapse-free), and seronegative NMOSD (64.7% continued treatment, 61.3% relapse-free). In 16 patients with associated steroids, 13 (81.2%) continued MMF till last follow-up versus 15 of 28 (53.6%) in the non-steroid group. Nine patients discontinued treatment for tolerability purpose. CONCLUSION: MMF showed effectiveness and good tolerability as a first-line therapy in NMOSD, whatever the AQP4-IgG status. Concomitant use of oral steroids at start could limit the risk of treatment failure.
OBJECTIVE: To evaluate the effectiveness and tolerance of mycophenolate mofetil (MMF) as a first-line treatment in neuromyelitis optica spectrum disorder (NMOSD). METHODS: In all, 67 NMOSD patients treated by MMF as first-line therapy, from the NOMADMUS cohort were included. A total of 65 fulfilled 2015 NMOSD criteria, and 5 were myelin oligodendrocyte glycoprotein (MOG)-immunoglobulin G (IgG) positive. Effectiveness was evaluated on percentage of patients continuing MMF, percentage of patients free of relapse, pre- and post-treatment change in the annualized relapse rate (ARR), and Expanded Disability Status Scale (EDSS). RESULTS: Among 67 patients, 40 (59.7%) continued treatment till last follow-up. A total of 33 (49.3%) were relapse-free. The median ARR decreased from one pre-treatment to zero post-treatment. Of 53 patients with complete EDSS data, the score improved or stabilized in 44 (83%; p < 0.05). Effectiveness was observed in aquaporin-4 (AQP4)-IgG (57.8% continued treatment, 46.7% relapse-free), MOG-IgG (3/5 continued treatment, 4/5 relapse-free), and seronegative NMOSD (64.7% continued treatment, 61.3% relapse-free). In 16 patients with associated steroids, 13 (81.2%) continued MMF till last follow-up versus 15 of 28 (53.6%) in the non-steroid group. Nine patients discontinued treatment for tolerability purpose. CONCLUSION:MMF showed effectiveness and good tolerability as a first-line therapy in NMOSD, whatever the AQP4-IgG status. Concomitant use of oral steroids at start could limit the risk of treatment failure.
Authors: Yael Hacohen; Yu Yi Wong; Christian Lechner; Maciej Jurynczyk; Sukhvir Wright; Bahadir Konuskan; Judith Kalser; Anne Lise Poulat; Helene Maurey; Esther Ganelin-Cohen; Evangeline Wassmer; Chery Hemingway; Rob Forsyth; Eva Maria Hennes; M Isabel Leite; Olga Ciccarelli; Banu Anlar; Rogier Hintzen; Romain Marignier; Jacqueline Palace; Matthias Baumann; Kevin Rostásy; Rinze Neuteboom; Kumaran Deiva; Ming Lim Journal: JAMA Neurol Date: 2018-04-01 Impact factor: 18.302
Authors: S Jarius; F Paul; O Aktas; N Asgari; R C Dale; J de Seze; D Franciotta; K Fujihara; A Jacob; H J Kim; I Kleiter; T Kümpfel; M Levy; J Palace; K Ruprecht; A Saiz; C Trebst; B G Weinshenker; B Wildemann Journal: Nervenarzt Date: 2018-12 Impact factor: 1.214
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Authors: D H Whittam; V Karthikeayan; E Gibbons; R Kneen; S Chandratre; O Ciccarelli; Y Hacohen; J de Seze; K Deiva; R Q Hintzen; B Wildemann; S Jarius; I Kleiter; K Rostasy; P Huppke; B Hemmer; F Paul; O Aktas; A K Pröbstel; G Arrambide; M Tintore; M P Amato; M Nosadini; M M Mancardi; M Capobianco; Z Illes; A Siva; A Altintas; G Akman-Demir; L Pandit; M Apiwattankul; J Y Hor; S Viswanathan; W Qiu; H J Kim; I Nakashima; K Fujihara; S Ramanathan; R C Dale; M Boggild; S Broadley; M A Lana-Peixoto; D K Sato; S Tenembaum; P Cabre; D M Wingerchuk; B G Weinshenker; B Greenberg; M Matiello; E C Klawiter; J L Bennett; A I Wallach; I Kister; B L Banwell; A Traboulsee; D Pohl; J Palace; M I Leite; M Levy; R Marignier; T Solomon; M Lim; S Huda; A Jacob Journal: J Neurol Date: 2020-07-04 Impact factor: 4.849