Wenjuan Huang1, Liang Wang1, Baojingzi Zhang1, Lei Zhou1, Tiansong Zhang2, Chao Quan3. 1. Department of Neurology, Huashan Hospital, Fudan University, Shanghai 200040, China. 2. Department of Chinese Traditional Medicine, Jing'an District Centre Hospital of Shanghai, Fudan University, Shanghai 200040, China. Electronic address: ztsdoctor@126.com. 3. Department of Neurology, Huashan Hospital, Fudan University, Shanghai 200040, China. Electronic address: chao_quan@fudan.edu.cn.
Abstract
BACKGROUND: Several immunosuppressants or monoclonal antibodies have been used as preventive treatment for neuromyelitis optica spectrum disorders (NMOSD); however, the optimal therapies have not been clarified. In this study, we aimed to compare and rank the effectiveness and tolerability of all preventive therapies for NMOSD. METHODS: Qualified studies were identified in a search of MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), and ClinicalTrials.gov databases. We combined direct and indirect evidence via meta-analyses. The annualized relapse rate (ARR) was defined as the primary outcome. Secondary outcomes included the Expanded Disability Status Scale (EDSS) score and hazard ratios (HR) for the counts of adverse events (AEs). RESULTS: We identified one randomized controlled trial (RCT) and five observational studies including a total 631 patients with NMOSD. Among these, the follow-up time ranged from 12 to 40 months. For the primary outcome, rituximab (RTX) was hierarchically superior, with the significant standardized mean difference versus azathioprine (-0.86; 95% confidence interval: -1.60, -0.11). Mycophenolate mofetil (MMF) was ranked the most tolerable therapy, whereas cyclophosphamide was the least tolerable. CONCLUSION: RTX and MMF may be recommended as optimal treatments to prevent relapse in NMOSD. Low-dose cyclosporine A could be a promising alternative therapy.
BACKGROUND: Several immunosuppressants or monoclonal antibodies have been used as preventive treatment for neuromyelitis optica spectrum disorders (NMOSD); however, the optimal therapies have not been clarified. In this study, we aimed to compare and rank the effectiveness and tolerability of all preventive therapies for NMOSD. METHODS: Qualified studies were identified in a search of MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), and ClinicalTrials.gov databases. We combined direct and indirect evidence via meta-analyses. The annualized relapse rate (ARR) was defined as the primary outcome. Secondary outcomes included the Expanded Disability Status Scale (EDSS) score and hazard ratios (HR) for the counts of adverse events (AEs). RESULTS: We identified one randomized controlled trial (RCT) and five observational studies including a total 631 patients with NMOSD. Among these, the follow-up time ranged from 12 to 40 months. For the primary outcome, rituximab (RTX) was hierarchically superior, with the significant standardized mean difference versus azathioprine (-0.86; 95% confidence interval: -1.60, -0.11). Mycophenolate mofetil (MMF) was ranked the most tolerable therapy, whereas cyclophosphamide was the least tolerable. CONCLUSION:RTX and MMF may be recommended as optimal treatments to prevent relapse in NMOSD. Low-dose cyclosporine A could be a promising alternative therapy.
Authors: Wajih Bukhari; Laura Clarke; Cullen O'Gorman; Elham Khalilidehkordi; Simon Arnett; Kerri M Prain; Mark Woodhall; Roger Silvestrini; Christine S Bundell; Sudarshini Ramanathan; David Abernethy; Sandeep Bhuta; Stefan Blum; Mike Boggild; Karyn Boundy; Bruce J Brew; Wallace Brownlee; Helmut Butzkueven; William M Carroll; Celia Chen; Alan Coulthard; Russell C Dale; Chandi Das; Keith Dear; Marzena J Fabis-Pedrini; David Fulcher; David Gillis; Simon Hawke; Robert Heard; Andrew P D Henderson; Saman Heshmat; Suzanne Hodgkinson; Sofia Jimenez-Sanchez; Trevor J Kilpatrick; John King; Chris Kneebone; Andrew J Kornberg; Jeannette Lechner-Scott; Ming-Wei Lin; Christopher Lynch; Richard A L Macdonnell; Deborah F Mason; Pamela A McCombe; Jennifer Pereira; John D Pollard; Stephen W Reddel; Cameron Shaw; Judith Spies; James Stankovich; Ian Sutton; Steve Vucic; Michael Walsh; Richard C Wong; Eppie M Yiu; Michael H Barnett; Allan G Kermode; Mark P Marriott; John Parratt; Mark Slee; Bruce V Taylor; Ernest Willoughby; Robert J Wilson; Fabienne Brilot; Angela Vincent; Patrick Waters; Simon A Broadley Journal: J Neurol Date: 2020-01-31 Impact factor: 4.849
Authors: Pilar Carrillo; Teresa Gorría; Daniel Santana; Maria Sepulveda; Iban Aldecoa; Blanca Gonzalez-Farré; Esther Sanfeliu; Eduard Mension; Isaac Cebrecos; Olga Martínez-Saez; Imma Alonso; Albert Saiz Journal: Biomed Hub Date: 2022-01-31