Work

Population-based national study of relapse-related outcomes in the aquaporin-4 antibody seropositive neuromyelitis optica spectrum disorder population

Year: 2025

Type: conference-paper

Abstract: Introduction & Aims Population-based Danish national study of relapse-related outcomes in patients with aquaporin-4 antibody seropositive neuromyelitis optica spectrum disorder (AQP4+ NMOSD). ● Time between initial relapse and initiation of immunosuppressive maintenance treatment and its association with the Expanded Disability Status Scale (EDSS). ● Annualized relapse rates. ● Type of initial relapse and the risk of developing more numerous or fewer attacks. ● Type of relapse and risk of developing other types of relapses. ● Number and type of relapse and its effect on EDSS. ● Age and its association with relapse severity and subsequent recovery. ● Association between immunosuppressive maintenance treatment, relapse treatment, recovery after relapses, and EDSS. Methods ● Nationwide retrospective cohort of 66 patients with AQP4-Ab+ NMOSD. ● Median follow-up time of 99.5 months (interquartile range: 39-188 months). ● Mixed-effects linear and logistic regression models were used to examine associations between: 1. Number of relapses and maintenance treatment and expanded disability status scale (EDSS) scores. 2. Type of relapse and its effect on the EDSS score changes. 3. Type of initial relapse and risk of developing other types of relapses and frequency of relapses. 4. Age and relapse severity. 5. Relapse treatment and recovery. Results ● Longer time before initiation of immunosuppressive maintenance treatment was associated with higher EDSS scores at the last follow-up. ● There was a higher risk of developing optic neuritis (ON) after transverse myelitis (TM) (OR: 3.21, 95% CI: 1.71-6.02; p <0.001) and, to a lesser degree, vice versa (OR: 2.91, 95% CI: 1.64-5.17; p <0.001). ● There was also a higher risk of BS relapse after TM (OR: 2.79, 95% CI: 1.21-6.43; p = 0.016) and, to a lesser degree, vice versa (OR: 2.40; 95% CI: 1.08-5.31; p = 0.031). ● ON was the only initial relapse type that was associated with a higher number of relapses at the last follow-up. ● Not receiving relapse treatment was associated with higher EDSS changes during the follow-up period. ● BS relapses were the only type of relapses associated with a higher EDSS at follow-up. ● Higher age and male sex were associated with more severe relapses of TM, and male sex was also associated with worse recovery after ON. ● Peroral methylprednisolone (p = 0.004), intravenous methylprednisolone (p < 0.001), and methylprednisolone combined with plasma exchange (p = 0.017) were associated with better recovery after ON. Conclusion Earlier initiation of immuno- suppressive maintenance treatment can limit the accumulation of disability in NMOSD. Our findings indicate certain relapse patterns in NMOSD, which could aid clinicians in tailoring patient monitoring and treatment choices. Funding This study was funded by Alexion Pharmaceuticals and the Danish Multiple Society (A39992).

Source: University of Southern Denmark Research Portal (University of Southern Denmark)

Authors: Mamoei, Sepehr; id_orcid 0000-0003-3140-4983, Möller, Sören; id_orcid 0000-0003-0858-4269, Magyari, Melinda, Sellebjerg, Finn Thorup, Frederiksen, Jette Lautrup, Svendsen, Kristina B., Saleem, Rasha, Søndergaard, Helle Bach, Nilsson, Anna Christine, Papp, Viktoria, Illés, Zsolt