Predictors of relapse risk and treatment response in AQP4-IgG positive and seronegative NMOSD: A multicentre study.
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Siriratnam Pakeeran, Sanfilippo Paul, van der Walt Anneke, Sharmin Sifat, Foong Yi Chao, Yeh Wei Zhen, Zhu Chao, Khoury Samia Joseph, Csepany Tunde, Willekens Barbara, Etemadifar Masoud, Ozakbas Serkan, Nytrova Petra, Altintas Ayse, Al-Asmi Abdullah, Yamout Bassem, Laureys Guy, Patti Francesco, Simo Magdolna, Surcinelli Andrea, Foschi Matteo, McCombe Pamela A, Alroughani Raed, Sánchez-Menoyo José Luis, Turkoglu Recai, Soysal Aysun, Lechner Scott Jeanette, Kalincik Tomas, Butzkueven Helmut, Jokubaitis Vilija, Huda Saif, Monif Mastura, MSBASE study group
Аннотация
METHODS: This was a multicentre, international, retrospective cohort study using the MSBase registry. Recurrent relapse risk was assessed using an Andersen-Gill model and risk of first relapse was evaluated using a Cox proportional hazards model. Covariates that putatively influence relapse risk included demographic factors, clinical characteristics and immunosuppressive therapies; the latter was assessed as a time-varying covariate.
RESULTS: A total of 398 patients (246 AQP4-IgG NMOSD and 152 seronegative NMOSD) were included. The AQP4-IgG NMOSD and seronegative NMOSD patients did not significantly differ by age at disease onset, ethnicity or annualised relapse rate. Both low-efficacy and high-efficacy immunosuppressive therapies were associated with significant reductions in recurrent relapse risk, with notably greater protection conferred by high-efficacy therapies in both AQP4-IgG NMOSD (HR 0.27, 95% CI 0.15 to 0.49, p<0.001) and seronegative NMOSD (HR 0.21, 95% CI 0.08 to 0.51, p<0.001). Longer disease duration (HR 0.97, 95% CI 0.95 to 0.99, p<0.001) and male sex (HR 0.52, 95% CI 0.34 to 0.84, p=0.007) were additional protective variables in reducing the recurrent relapse risk for the AQP4-IgG NMOSD group.
CONCLUSION: Although further studies are needed to improve our understanding of seronegative NMOSD, our findings underscore the importance of aggressive treatment with high-efficacy immunotherapies in both NMOSD subtypes, regardless of serostatus.