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Title: Response to treatment in NMOSD: the Australasian experience.
Austin Authors: Clarke, Laura;Bukhari, Wajih;O'Gorman, Cullen M;Khalilidehkordi, Elham;Arnett, Simon;Woodhall, Mark;Prain, Kerri M;Parratt, John D E;Barnett, Michael H;Marriott, Mark P;McCombe, Pamela A;Sutton, Ian;Boggild, Mike;Brownlee, Wallace;Carroll, William M;Hodgkinson, Suzanne;Macdonell, Richard A L ;Mason, Deborah F;Pereira, Jennifer;Slee, Mark;Das, Chandi;Henderson, Andrew P D;Kermode, Allan G;Lechner-Scott, Jeannette;Waters, Patrick;Sun, Jing;Broadley, Simon A
Affiliation: Department of Neurology, Auckland City Hospital, Grafton 1023, New Zealand..
Department of Neurology Princess Alexandra Hospital, Woolloongabba QLD 4102, Australia..
Department of Neurology, Westmead Hospital, Westmead NSW 2145, Australia..
Hunter Medical Research Institute, University of Newcastle, New Lambton Heights NSW 2305, Australia..
Department of Neurology, Gold Coast University Hospital, Southport QLD 4215, Australia..
Menzies Health Institute Queensland, Gold Coast Campus, Griffith University QLD 4222, Australia..
St Vincent's Hospital Melbourne, Fitzroy VIC 3065, Australia..
Institute for Immunology and Infectious Disease, Murdoch University, Murdoch WA 6150, Australia..
Centre for Clinical Research, Royal Brisbane and Women's Hospital, University of Queensland, Herston QLD 4029, Australia..
Department of Neurology, Royal Brisbane and Women's Hospital, Herston QLD 4029, Australia..
Department of Neurology, Mater Hospital Brisbane, South Brisbane QLD, 4101, Australia..
Nuffield Department of Clinical Neurosciences, John Radcliffe Infirmary, University of Oxford, Oxford OX3 9DU, UK..
Department of Immunology, Pathology Queensland, Royal Brisbane and Women's Hospital, Herston QLD 4006, Australia..
Sydney Medical School, Royal Prince Alfred Hospital, University of Sydney, Camperdown NSW 2006, Australia..
Brain and Mind Research Institute, University of Sydney, Camperdown NSW 2006, Australia..
Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Parkville VIC 3052, Australia..
Department of Neurology, St Vincent's Hospital, Darlinghurst NSW 2010, Australia..
Department of Neurology, Townsville Hospital, Douglas QLD 4814, Australia..
Centre for Neuromuscular and Neurological Disorders, Perron Institute for Neurological and Translational Science, Queen Elizabeth II Medical Centre, University of Western Australia, Nedlands WA 6009, Australia..
South Western Sydney Medical School, Liverpool Hospital, University of New South Wales, Liverpool NSW 2170, Australia..
Flinders Medical Centre, Flinders University, Bedford Park SA 5042, Australia..
Department of Neurology, Canberra Hospital, Garran ACT 2605, Australia..
Department of Neurology, Christchurch Hospital, Christchurch 8140, New Zealand..
Institute of Neurology, University College London, Queen Square, London WC1N 3BG, UK..
Issue Date: Feb-2022
Date: 2021
Publication information: Multiple sclerosis and related disorders 2022; 58: 103408
Abstract: Neuromyelitis optica spectrum disorder (NMOSD) is associated with significant morbidity and mortality. Several therapies have been recommended for NMOSD and more recently clinical trials have demonstrated efficacy for three monoclonal antibody therapies. We present a retrospective observational study of treatment response in NMOSD. This was a retrospective, unblinded, observational study of treatment efficacy for rituximab and traditional immunosuppressive therapy in patients with AQP4 antibody positive NMOSD. Treatment efficacy was assessed using annualised relapse rates (ARR), time to first relapse and expanded disability status scale (EDSS) scores. Complete relapse and treatment data were available for 43/68 (63%) of AQP4 antibody positive NMOSD cases covering 74 episodes of treatment. In a time to first relapse analysis rituximab showed a risk ratio of 0.23 (95% CI 0.08 - 0.65) when compared with no treatment and there was a non-significant reduction in ARR of 35% compared to pre-treatment. β-interferon (p = 0.0002) and cyclophosphamide (p = 0.0034) were associated with an increased ARR compared to pre-treatment. Rituximab (median 4.0 [range 0.0 - 7.0]; p = 0.042) and traditional immunosuppressive therapy (median 4.0 [range 0.0 - 8.0]; p = 0.016) were associated with a lower final EDSS compared to β-interferon (median 6.0 [range 4.0 - 7.5]). These data provide additional support for the use of rituximab in preference to traditional immunosuppressive agents and MS disease modifying therapies as first line treatment of NMOSD.
DOI: 10.1016/j.msard.2021.103408
ORCID: 0000-0001-6604-3968
Journal: Multiple sclerosis and related disorders
PubMed URL: 35216788
PubMed URL:
Type: Journal Article
Subjects: Aquaporin
Autoimmune disease
Clinical features
Multiple sclerosis
Neuromyelitis optica
Appears in Collections:Journal articles

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