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. 2018 Nov;24(13):1737-1742.
doi: 10.1177/1352458517730131. Epub 2017 Aug 31.

Aquaporin-4 serostatus does not predict response to immunotherapy in neuromyelitis optica spectrum disorders

Maureen A Mealy  1 , Su-Hyun Kim  2 , Felix Schmidt  3 , Reydmar López  4 , Jorge A Jimenez Arango  4 , Friedemann Paul  3 , Dean M Wingerchuk  5 , Benjamin M Greenberg  6 , Ho Jin Kim  2 , Michael Levy  1
Affiliations

Aquaporin-4 serostatus does not predict response to immunotherapy in neuromyelitis optica spectrum disorders

Maureen A Mealy et al. Mult Scler. 2018 Nov.

Abstract

Background: Debate exists about whether neuromyelitis optica spectrum disorder seronegative disease represents the same immune-mediated attack on astrocytic aquaporin-4 as in seropositive disease.

Objective: We investigated whether response to common treatments for neuromyelitis optica spectrum disorder differed by serostatus, as assessed by change in annualized relapse rate.

Methods: We performed a multicenter retrospective analysis of 245 patients with neuromyelitis optica spectrum disorder who were treated with either rituximab or mycophenolate mofetil as their first-line immunosuppressive treatment for disease prevention. Patients were followed for a minimum of 6 months following treatment initiation.

Results: In those started on rituximab, the pre-treatment annualized relapse rates for seropositive and seronegative patients were 1.81 and 1.93, respectively. On-treatment annualized relapse rates significantly declined to 0.32 (seropositive; p < 0.0001) and 0.12 (seronegative; p = 0.0001). In those started on mycophenolate mofetil, the pre-treatment annualized relapse rates for seropositive and seronegative patients were 1.79 and 1.45, respectively. On-treatment annualized relapse rates declined to 0.29 (seropositive; p < 0.0001) and 0.30 (seronegative; p < 0.005).

Conclusion: In this international collaboration involving a large number of neuromyelitis optica spectrum disorder patients, treatment was effective regardless of serostatus. This suggests that treatment should not differ when considering these treatments.

Keywords: Devic’s disease; immunosuppression; mycophenolate; neuromyelitis optica; relapse; rituximab.

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Conflict of interest statement

Declaration of Conflicting Interests: the authors declare there are no conflicts of interest

Figures

Figure 1
Figure 1
Comparison of annualized relapse rate before and after initiation of rituximab: A. patients with AQP4 seropositive NMOSD (p<0.0001), B. patients with AQP4 seronegative NMOSD (p=0.0001).
Figure 2
Figure 2
Comparison of annualized relapse rate before and after initiation of mycophenolate mofetil: A. patients with AQP4 seropositive NMOSD (p<0.0001), B. patients with AQP4 seronegative NMOSD (p=0.0039)
See this image and copyright information in PMC

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