Analysis of the immunotherapy and relapse factors during the remission phase of neuromyelitis optica spectrum disorders
Objective To analyze the immunotherapy and relapse situation in patients with neuromyelitis optica spectrum disorder(NMOSD)during the remission phase,and to explore the effects of immunotherapy in preventing disease relapses and the factors influencing relapses.Methods A single-center cohort retrospective study was conducted,collecting consecutive non-repeat cases of NMOSD from the database of patients admitted to the Department of Neurology at Beijing Tongren Hospital from December 1,2017,to December 1,2019.Demographic characteristics,immunotherapy,expanded disability status scale(EDSS)scores,and relapse situations were retrospectively analyzed,with follow-up until the first clinical relapse after enrollment.Clinical characteristics of patients who relapsed and those who did not were compared,and the COX multivariate regression analysis was conducted to analyze the factors affecting relapses.Results A total of 161 NMOSD patients were collected,with 23 males(14.3%)and 138 females(85.7%).Among them,85 patients(53.1%)had experienced more than one episode,with a median annualized relapse rate(ARR)of 0.85(0.36,2.16).At enrollment,only 5 patients(3.1%)had received preventive immunotherapy,which increased to 99 patients(61.5%)after enrollment,showing a statistically significant difference(P<0.05).A total of 145 patients completed follow-up,with a median follow-up time of 718.0(501.5,991.0)days,among which 73 patients(50.3%)experienced relapses.At the last follow-up,73 patients(50.3%)received continued preventive immunotherapy,with a median treatment duration of 998.0(633.5,1937.0)days.The top three immunotherapy used during remission were mycophenolate mofetil,rituximab,and azathioprine.The median ARR at the last follow-up decreased to 0.10(0.00,0.71),which showed a statistically significant difference from the baseline(P<0.05).COX multivariate regression analysis showed that antinuclear antibody(ANA)positive(HR=2.471,95%CI:1.266 to 4.823)and rituximab treatment(HR=3.365,95%CI:1.021 to 11.089)were associated with a reduced risk of NMOSD relapse,while having non-optic nerve-spinal cord core symptoms at enrollment was associated with an increased risk of NMOSD relapse(HR=0.255,95%CI:0.092 to 0.712).Conclusion Regular preventive immunotherapy can reduce the relapse rate of NMOSD.Rituximab treatment and ANA-positive patients have a reduced risk of NMOSD relapse,while the presence of non-optic nerve-spinal cord symptoms indicates an increased risk of NMOSD relapse,suggesting the need for more aggressive preventive immunotherapy strategies.
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