Treatment of Neuromyelitis Optica With Mycophenolate Mofetil

Abstract

Background: Neuromyelitis optica (NMO) is the first inflammatory autoimmune demyelinating disease of the central nervous system for which a specific antigenic target has been identified; the marker autoantibody NMO-IgG specifically recognizes the astrocytic water channel aquaporin 4. Current evidence strongly suggests that NMO-IgG may be pathogenic. Since disability accrues incrementally related to attacks, attack prevention with immunosuppressive therapy is the mainstay of preventing disability. Objective: To evaluate the efficacy and safety of mycophenolate mofetil therapy in NMO spectrum disorders. Design: Retrospective case series with prospective telephone follow-up.

Azathioprine plus corticosteroid treatment in Chinese patients with neuromyelitis optica

“…We also observed that 20.8% (16/77) of patients experienced a higher ARR after treatment suggesting a suboptimal response. This finding is in accordance with other reports stating that patients relapsed during follow-up despite immunosuppressant treatment [5,11]. This finding raises the question of whether AZA (or other traditional immunosuppressive drugs) confer beneficial effects for all patients.…”

Azathioprine plus corticosteroid treatment in Chinese patients with neuromyelitis optica

“…We also observed that 20.8% (16/77) of patients experienced a higher ARR after treatment suggesting a suboptimal response. This finding is in accordance with other reports stating that patients relapsed during follow-up despite immunosuppressant treatment [5,11]. This finding raises the question of whether AZA (or other traditional immunosuppressive drugs) confer beneficial effects for all patients.…”

Comparative analysis of treatment outcomes in patients with neuromyelitis optica spectrum disorder using multifaceted endpoints

“…The present study provides the first comparative analysis of multifaceted endpoints, including annualized severe relapse rate and time to first severe relapse, in patients with NMOSD taking azathioprine, MMF, and rituximab. Consistent with previous studies, 2–17 all three treatments significantly reduced relapse rates, Additionally, initial treatment with each drug consistently reduced annualized severe relapse rates. Due to the nature of attack-related disabilities in NMOSD patients, the attenuation of attack severity as well as reductions in relapse rates should be important considerations when evaluating the therapeutic efficacies of immunosuppressive treatments.…”

Methotrexate is an alternative to azathioprine in neuromyelitis optica spectrum disorders with aquaporin-4 antibodies

“…Eighty-six per cent of patients experienced a reduction in ARR after commencing methotrexate, and EDSS stabilised or improved in 79% of patients. This is comparable with mycophenolate, which has been reported to reduce ARR in 79% of patients and stabilise disability in 91%4 and azathioprine, which was recently reported to reduce ARR in 76% of patients, with EDSS stabilising in 60% 3. In those given an adequate trial of methotrexate (3 months or more of treatment and an adequate dose (≥10 mg weekly)), 64% were relapse free.…”

Azathioprine plus corticosteroid treatment in Chinese patients with neuromyelitis optica

“…We also observed that 20.8% (16/77) of patients experienced a higher ARR after treatment suggesting a suboptimal response. This finding is in accordance with other reports stating that patients relapsed during follow-up despite immunosuppressant treatment [5,11]. This finding raises the question of whether AZA (or other traditional immunosuppressive drugs) confer beneficial effects for all patients.…”

Comparative analysis of treatment outcomes in patients with neuromyelitis optica spectrum disorder using multifaceted endpoints

“…The present study provides the first comparative analysis of multifaceted endpoints, including annualized severe relapse rate and time to first severe relapse, in patients with NMOSD taking azathioprine, MMF, and rituximab. Consistent with previous studies, 2–17 all three treatments significantly reduced relapse rates, Additionally, initial treatment with each drug consistently reduced annualized severe relapse rates. Due to the nature of attack-related disabilities in NMOSD patients, the attenuation of attack severity as well as reductions in relapse rates should be important considerations when evaluating the therapeutic efficacies of immunosuppressive treatments.…”

Methotrexate is an alternative to azathioprine in neuromyelitis optica spectrum disorders with aquaporin-4 antibodies

“…Eighty-six per cent of patients experienced a reduction in ARR after commencing methotrexate, and EDSS stabilised or improved in 79% of patients. This is comparable with mycophenolate, which has been reported to reduce ARR in 79% of patients and stabilise disability in 91%4 and azathioprine, which was recently reported to reduce ARR in 76% of patients, with EDSS stabilising in 60% 3. In those given an adequate trial of methotrexate (3 months or more of treatment and an adequate dose (≥10 mg weekly)), 64% were relapse free.…”

Azathioprine plus corticosteroid treatment in Chinese patients with neuromyelitis optica

“…We also observed that 20.8% (16/77) of patients experienced a higher ARR after treatment suggesting a suboptimal response. This finding is in accordance with other reports stating that patients relapsed during follow-up despite immunosuppressant treatment [5,11]. This finding raises the question of whether AZA (or other traditional immunosuppressive drugs) confer beneficial effects for all patients.…”

Comparative analysis of treatment outcomes in patients with neuromyelitis optica spectrum disorder using multifaceted endpoints

“…The present study provides the first comparative analysis of multifaceted endpoints, including annualized severe relapse rate and time to first severe relapse, in patients with NMOSD taking azathioprine, MMF, and rituximab. Consistent with previous studies, 2–17 all three treatments significantly reduced relapse rates, Additionally, initial treatment with each drug consistently reduced annualized severe relapse rates. Due to the nature of attack-related disabilities in NMOSD patients, the attenuation of attack severity as well as reductions in relapse rates should be important considerations when evaluating the therapeutic efficacies of immunosuppressive treatments.…”

Methotrexate is an alternative to azathioprine in neuromyelitis optica spectrum disorders with aquaporin-4 antibodies

“…Eighty-six per cent of patients experienced a reduction in ARR after commencing methotrexate, and EDSS stabilised or improved in 79% of patients. This is comparable with mycophenolate, which has been reported to reduce ARR in 79% of patients and stabilise disability in 91%4 and azathioprine, which was recently reported to reduce ARR in 76% of patients, with EDSS stabilising in 60% 3. In those given an adequate trial of methotrexate (3 months or more of treatment and an adequate dose (≥10 mg weekly)), 64% were relapse free.…”