Immunosuppressive therapy in elderly patients with neuromyelitis optica spectrum disorder: a retrospective multicentre study.

Autor:	Kim KH; Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang, Korea (the Republic of).; Department of Neurology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea (the Republic of)., Chung YH; Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of).; Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea (the Republic of)., Min JH; Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)., Han HJ; Department of Neurology, Yonsei University College of Medicine, Seoul, Korea (the Republic of)., Kim SW; Department of Neurology, Yonsei University College of Medicine, Seoul, Korea (the Republic of)., Shin HY; Department of Neurology, Yonsei University College of Medicine, Seoul, Korea (the Republic of)., Kwon YN; Department of Neurology, Yonsei University College of Medicine, Seoul, Korea (the Republic of).; Department of Neurology, Seoul National University College of Medicine, Seoul, Korea (the Republic of)., Kim SM; Department of Neurology, Seoul National University College of Medicine, Seoul, Korea (the Republic of)., Lim YM; Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (the Republic of)., Kim H; Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (the Republic of)., Lee EJ; Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (the Republic of)., Jeong SH; Department of Neurology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea (the Republic of)., Hyun JW; Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang, Korea (the Republic of)., Kim SH; Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang, Korea (the Republic of) herena20@ncc.re.kr., Kim HJ; Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang, Korea (the Republic of).
Jazyk:	angličtina
Zdroj:	Journal of neurology, neurosurgery, and psychiatry [J Neurol Neurosurg Psychiatry] 2024 Nov 18; Vol. 95 (12), pp. 1168-1175. Date of Electronic Publication: 2024 Nov 18.
DOI:	10.1136/jnnp-2024-333644
Abstrakt:	Background: The risk-benefit relationship of immunosuppressive therapies (ISTs) for elderly patients with neuromyelitis optica spectrum disorder (NMOSD) is not well established. This study aimed to investigate the safety and efficacy of IST in elderly patients with NMOSD. Methods: This retrospective study analysed IST efficacy and safety in 101 patients with aquaporin-4 antibody-positive NMOSD aged over 65 years, treated for at least 6 months at five Korean referral centres, focusing on relapse rates, infection events and discontinuation due to adverse outcomes. Results: The mean age at disease onset was 59.8 years, and female-to-male ratio was 4:1. Concomitant comorbidities at NMOSD diagnosis were found in 87 patients (86%). The median Expanded Disability Status Scale score at the initiation of IST was 3.5. The administered ISTs included azathioprine (n=61, 60%), mycophenolate mofetil (MMF) (n=48, 48%) and rituximab (n=41, 41%). Over a median of 5.8 years of IST, 58% of patients were relapse-free. The median annualised relapse rate decreased from 0.76 to 0 (p<0.001), and 81% experienced improved or stabilised disability. Patients treated with rituximab had a higher relapse-free rate than those treated with azathioprine or MMF (p=0.022). During IST, 21 patients experienced 25 severe infection events (SIEs) over the age of 65 years, and 3 died from pneumonia. 14 patients (14%) experienced 17 adverse events that led to switching or discontinuation of IST. When comparing the incidence rates of SIEs and adverse events, no differences were observed among patients receiving azathioprine, MMF and rituximab. Conclusion: In elderly patients with NMOSD, IST offers potential benefits in reducing relapse rates alongside a tolerable risk of adverse events. Competing Interests: Competing interests: KHK, Y-ML, HK, YHC, HJH, SWK, SHJ, HYS and E-JL report no disclosures. S-HK has lectured, consulted and received honoraria from Bayer Schering Pharma, Biogen, Genzyme, Merck Serono and UCB; and received a grant from the National Research Foundation of Korea. J-WH has received a grant from the National Research Foundation of Korea. HJK received a grant from the National Research Foundation of Korea and research support from Aprilbio and Eisai; received consultancy/speaker fees from Alexion, Aprilbio, Altos Biologics, Biogen, Celltrion, Daewoong, Eisai, GC Pharma, Handok, Horizon Therapeutics, Kaigene, Kolon Life Science, MDimune, Mitsubishi Tanabe Pharma, Merck Serono, Novartis, Roche, Sanofi Genzyme, Teva-Handok and UCB; is a co-editor for the Multiple Sclerosis Journal and an associated editor for the Journal of Clinical Neurology. YNK has received a grant from the National Research Foundation of Korea, the Korea Health Industry Development Institute Research and Eisai; and also has lectured, consulted and received honoraria from Celltrion, Eisai, GC Pharma, Merck Serono, Roche and Sanofi Genzyme. J-HM is funded by and has received research support from the National Research Foundation of Korea (MIST and KHIDI) and SMC Research and Development Grant. She has lectured, consulted and received honoraria from Bayer Healthcare, Merck, Biogen Idec, Sanofi, UCB, Samsung Bioepis, Mitsubishi Tanabe, Celltrion, Roche, Janssen and AstraZeneca. S-MK has lectured, consulted and received honoraria from Bayer Schering Pharma, Genzyme, Merck Serono, Eisai and UCB; received a grant from the National Research Foundation of Korea and the Korea Health Industry Development Institute Research; and is an associate editor of the Journal of Clinical Neurology. (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)
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