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

Maureen A. Mealy, Su Hyun Kim, Felix Schmidt, Reydmar López, Jorge A. Jimenez Arango, Friedemann Paul, Dean M. Wingerchuk, Benjamin M. Greenberg, Ho Jin Kim, Michael Levy

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)1737-1742
Number of pages6
JournalMultiple Sclerosis Journal
Volume24
Issue number13
DOIs
StatePublished - Nov 1 2018

Keywords

  • Devic’s disease
  • immunosuppression
  • mycophenolate
  • neuromyelitis optica
  • relapse
  • rituximab

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

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    Mealy, M. A., Kim, S. H., Schmidt, F., López, R., Jimenez Arango, J. A., Paul, F., Wingerchuk, D. M., Greenberg, B. M., Kim, H. J., & Levy, M. (2018). Aquaporin-4 serostatus does not predict response to immunotherapy in neuromyelitis optica spectrum disorders. Multiple Sclerosis Journal, 24(13), 1737-1742. https://doi.org/10.1177/1352458517730131