Neuromyelitis Optica Treatment

Abstract

Patients: Thirty-six patients with relapsing-remitting optic-spinal disease; long, extending spinal cord lesions; and brain magnetic resonance images not meeting Barkhof criteria for multiple sclerosis, thus fulfilling the 1999 and 2006 criteria for neuromyelitis optica. Patients were followed up from 1994 to 2007.Main Outcome Measures: Relapses and accumulation of disability.Results: Mean follow-up time was 47.2 months and mean ageatonsetwas32.3years.Sixty-fourtreatmentswereimple-mentedin36patients,whichincludedinterferonbeta,methotrexate, cyclophosphamide, prednisone, and azathioprine solely or plus prednisone. Patients who were treated with azathioprine or azathioprine with prednisone had a reduction in the occurrence of relapses and Expanded Disability Severity Scale score stabilization, as opposed to patients who received other treatments. Of the 4 patients who died, only 1 had received azathioprine treatment. Conclusion:Azathioprine as monotherapy or with prednisone seems to have reduced the relapse frequency and halted disability progression in the majority of patients treated, with minor and manageable adverse effects.

Present and Future Therapies in Neuromyelitis Optica Spectrum Disorders

“…Several studies including a total of almost 400 patients have shown that AZA reduces the ARR, sometimes associated with improvement of neurological disability [17,[74][75][76][77][78][79][80]. A retrospective study evaluating classical NMO and patients with AQP4-IgG-positive NMOSD reported a decrease in the mean ARR from 2.18 to 0.64 in 70 patients treated with AZA for >1 year, with or without concomitant corticosteroid therapy [77].…”

“…Adjunctive therapy of AZA [17,75,77,79], MMF [79,83], MTX [85][86][87], ciclosporine A [88], and tacrolimus [89] with oral corticosteroids have all been reported to be (partly) effective and safe in NMOSD. In breakthrough disease intermittent TPE might be added to immunosuppressive treatment [8,98], but usually escalation to a biological is preferable.…”

Acute inflammatory myelopathies

“…In addition to PLEX and IVIg, uncontrolled case series suggest that use of immune suppressants including CTX (idiopathic transverse myelitis, SLE) (D'Cruz et al, 2004;Greenberg et al, 2007), rituximab (NMO) Jacob et al, 2008a), and azathioprine (NMO), (Bichuetti et al, 2010) might be helpful.…”

Seasonality of 278 neuromyelitis optica relapses in a Brazilian cohort

“…All patients received regular preventive therapies recommended at the time they were seen, which included, corticosteroids, azathioprine, cyclophosphamide, methotrexate, plasma exchange and IV immunoglobulin 7 . This work is part of an continuous observational project at the Universidade Federal de São Paulo, has received local ethic committee approval and patients have given informed consent for retrospective and prospective data collection.…”

“…Since this analysis comes from a historical cohort, information on vitamin D levels was not available and this should be prospectively evaluated together with other factors, such as the association to common infection and physical and psychological stress factors. Most of these patients received regular immunosuppressive treatment with azathioprine with or without prednisone as part of our regular treatment protocol, with 76% response 7 , and thus treatment biases is expected to not have influenced these results.…”