Su-Hyun Kim1, Jae-Won Hyun1, AeRan Joung1, Eun Young Park2, Jungnam Joo2, Ho Jin Kim1. 1. Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang-si, Korea. 2. Biometric Research Branch, Research Institute and Hospital of National Cancer Center, Goyang-si, Korea.
Abstract
BACKGROUND: Azathioprine (AZA) and mycophenolate mofetil (MMF) are the most commonly used first-line therapies for patients with neuromyelitis optica spectrum disorders (NMOSD). However, some patients experience a relapse following AZA or MMF treatment. OBJECTIVES: To identify factors that predict a response to AZA or MMF in NMOSD. METHODS: We retrospectively evaluated medical records from 116 patients who were initially treated with AZA or MMF for at least 6 months. Poor response was defined as ⩾2 relapses or ⩾1 severe relapse. RESULTS: Among the 116 patients, 40 (34%) were classified as poor responders. Logistic regression analyses revealed that a poor response was independently associated with a pre-treatment history of a severe attack ( p < 0.001) and a younger age at disease onset ( p = 0.022). Among the 40 patients with a poor response, 29 (73%) switched to rituximab, and only 3 (10%) had a poor response to rituximab. CONCLUSION: Patients with a pre-treatment history of a severe attack and a younger age of onset exhibited an increased risk of a poor response to AZA or MMF therapy. Identifying patients who are unlikely to respond to AZA or MMF therapy may allow for treatment with more potent therapies that improve treatment outcomes.
BACKGROUND:Azathioprine (AZA) and mycophenolate mofetil (MMF) are the most commonly used first-line therapies for patients with neuromyelitis optica spectrum disorders (NMOSD). However, some patients experience a relapse following AZA or MMF treatment. OBJECTIVES: To identify factors that predict a response to AZA or MMF in NMOSD. METHODS: We retrospectively evaluated medical records from 116 patients who were initially treated with AZA or MMF for at least 6 months. Poor response was defined as ⩾2 relapses or ⩾1 severe relapse. RESULTS: Among the 116 patients, 40 (34%) were classified as poor responders. Logistic regression analyses revealed that a poor response was independently associated with a pre-treatment history of a severe attack ( p < 0.001) and a younger age at disease onset ( p = 0.022). Among the 40 patients with a poor response, 29 (73%) switched to rituximab, and only 3 (10%) had a poor response to rituximab. CONCLUSION:Patients with a pre-treatment history of a severe attack and a younger age of onset exhibited an increased risk of a poor response to AZA or MMF therapy. Identifying patients who are unlikely to respond to AZA or MMF therapy may allow for treatment with more potent therapies that improve treatment outcomes.
Authors: Jan-Patrick Stellmann; Markus Krumbholz; Tim Friede; Anna Gahlen; Nadja Borisow; Katrin Fischer; Kerstin Hellwig; Florence Pache; Klemens Ruprecht; Joachim Havla; Tania Kümpfel; Orhan Aktas; Hans-Peter Hartung; Marius Ringelstein; Christian Geis; Christoph Kleinschnitz; Achim Berthele; Bernhard Hemmer; Klemens Angstwurm; Kim Lea Young; Simon Schuster; Martin Stangel; Florian Lauda; Hayrettin Tumani; Christoph Mayer; Lena Zeltner; Ulf Ziemann; Ralf Andreas Linker; Matthias Schwab; Martin Marziniak; Florian Then Bergh; Ulrich Hofstadt-van Oy; Oliver Neuhaus; Uwe Zettl; Jürgen Faiss; Brigitte Wildemann; Friedemann Paul; Sven Jarius; Corinna Trebst; Ingo Kleiter Journal: J Neurol Neurosurg Psychiatry Date: 2017-06-01 Impact factor: 10.154