Factors affecting relapse rate in patients with neuromyelitis optica spectrum disorder

Background: Few reports describe the influence pregnancy has on the annualized relapse rate (ARR) in neuromyelitis optica spectrum disorder (NMOSD). Objective: To examine pregnancy-related attacks (attacks during pregnancy or within 1 year postpartum) and identify the risk factors for an attack in Japanese NMOSD patients. Methods: We retrospectively reviewed 139 Japanese women whom had aquaporin-4 (AQP4) antibody-positive NMOSD. Among the 114 patients with information, 47 women had 56 pregnancies. We compared the ARR before, during and after pregnancy. Results: Of the 47 NMOSD patients with pregnancy, 22 women (46.8%) had a pregnancy-related attack of the disease (either an onset event or a relapse). The ARR was significantly higher in the first 3 months postpartum (1.80 ± 2.04), than before the pregnancy (0.57 ± 1.16; p = 0.0043) and did not significantly decrease during pregnancy. The ARR before hospitalization and treatment was analyzable in 55 patients without pregnancy and was 1.09 ± 1.17. Among the 11 patients with onset before pregnancy, nine patients had a pregnancy-related attack with a relapse in the previous year, and their immunosuppression was discontinued or made to be at low doses; while the two patients on higher-dose therapies were relapse-free. Conclusion: In the present study, pregnancy-related attack was common in NMOSD, and unlike in multiple sclerosis, the ARR was not reduced during pregnancy. Discontinued or insufficient immunosuppression appeared to increase the risk of pregnancy-related attack.

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Comparative analysis of treatment outcomes in patients with neuromyelitis optica spectrum disorder using multifaceted endpoints

Multiple Sclerosis Journal ◽

10.1177/1352458515587752 ◽

2015 ◽

Vol 22 (3) ◽

pp. 329-339 ◽

Cited By ~ 48

Author(s):

In Hye Jeong ◽

Boram Park ◽

Su-Hyun Kim ◽

Jae-Won Hyun ◽

Jungnam Joo ◽

...

Keyword(s):

Treatment Outcomes ◽

Relapse Rate ◽

Neuromyelitis Optica ◽

Treatment Options ◽

Unmet Need ◽

Spectrum Disorder ◽

Neuromyelitis Optica Spectrum Disorder ◽

Hazard Ratios ◽

First Relapse ◽

The Times

Background: There is still an unmet need for comparative analyses of available treatment options for neuromyelitis optica spectrum disorder (NMOSD). Objective: We aimed to compare the efficacies of the immunosuppressants most commonly prescribed for patients with NMOSD using multifaceted endpoints. Methods: We conducted a retrospective analysis of treatment outcomes in 138 NMOSD patients treated with azathioprine, mycophenolate mofetil (MMF), or rituximab. The primary outcome measures were the annualized relapse rate (ARR), annualized severe relapse rate, time to first relapse, and time to first severe relapse. Results: A comparison of any relapse among the groups revealed that the azathioprine had a significantly higher risk of relapse relative to the rituximab (hazard ratio: 1.82; 95% CI: 1.1–3.1; p=0.03). A comparison of severe relapse among the groups revealed that the hazard ratios of severe relapse for the azathioprine and MMF relative to the rituximab were 11.66 (95% CI: 2.6–52.3; p=0.001) and 5.96 (95% CI: 1.0–35.1; p=0.048), respectively. The times to first relapse and first severe relapse were also significantly different among the treatment groups Conclusions: The present study showed that reductions in the risks of relapse and severe relapse differed among patients who were initially treated with azathioprine, MMF, and rituximab.

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High risk of postpartum relapses in neuromyelitis optica spectrum disorder

Neurology ◽

10.1212/wnl.0000000000004681 ◽

2017 ◽

Vol 89 (22) ◽

pp. 2238-2244 ◽

Cited By ~ 30

Author(s):

Eric C. Klawiter ◽

Riley Bove ◽

Liene Elsone ◽

Enrique Alvarez ◽

Nadja Borisow ◽

...

Keyword(s):

High Risk ◽

Relapse Rate ◽

Neuromyelitis Optica ◽

Postpartum Period ◽

Baseline Period ◽

Spectrum Disorder ◽

Initial Symptom ◽

Neuromyelitis Optica Spectrum Disorder ◽

Medical Centers ◽

Period 2

Objective:To study the effect of pregnancy on the frequency of neuromyelitis optica spectrum disorder (NMOSD) relapse and evaluate rates of pregnancy-related complications in an international multicenter setting.Methods:We administered a standardized survey to 217 women with NMOSD from 7 medical centers and reviewed their medical records. We compared the annualized relapse rate (ARR) during a baseline period 2 years prior to a participant's first pregnancy to that during pregnancy and to the 9 months postpartum. We also assessed pregnancy-related complications.Results:There were 46 informative pregnancies following symptom onset in 31 women with NMOSD. Compared to baseline (0.17), ARR was increased both during pregnancy (0.44; p = 0.035) and during the postpartum period (0.69; p = 0.009). The highest ARR occurred during the first 3 months postpartum (ARR 1.33). A total of 8 of 76 (10.5%) with onset of NMOSD prior to age 40 experienced their initial symptom during the 3 months postpartum, 2.9 times higher than expected.Conclusions:The postpartum period is a particularly high-risk time for initial presentation of NMOSD. In contrast to published observations in multiple sclerosis, in neuromyelitis optica, relapse rate during pregnancy was also increased, although to a lesser extent than after delivery.

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Association of neutrophil-to-lymphocyte ratio (NLR) with the prognosis of first attack neuromyelitis optica spectrum disorder (NMOSD): a retrospective cohort study

BMC Neurology ◽

10.1186/s12883-021-02432-0 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Haojie Xie ◽

Yi Zhao ◽

Chunyang Pan ◽

Jinwei Zhang ◽

Yongyan Zhou ◽

...

Keyword(s):

Relapse Rate ◽

Neuromyelitis Optica ◽

Spectrum Disorder ◽

Neuromyelitis Optica Spectrum Disorder ◽

Lymphocyte Ratio ◽

Poor Recovery ◽

Kaplan Meier ◽

The Relationship ◽

Relapse Rates

Abstract Background To investigate the relationship between the neutrophil-to-lymphocyte ratio (NLR) and prognosis after the first attack of optic neuromyelitis optica spectrum disorder (NMOSD). Methods In this retrospective study, we included the medical records of 324 patients with first episode NMOSD and collected data on clinical parameters. Follow-up extended disability status scale (EDSS) score and relapse rate were analyzed using logistic regression models to determine the independent effect of NLR on outcomes; receiver operating characteristic (ROC) curves were applied to analyze the predictive value of NLR for the prognosis of NMOSD. Interaction and stratification analyses were used to explore the association between NLR and prognosis of patients with NMOSD, and Kaplan-Meier analysis was used to investigate the relationship between NLR and outcome. The association between NLR level with relapse rate and poor recovery was assessed by a Cox regression analysis. Results Patients in the high-NLR group had significantly higher EDSS scores and relapse rates at follow-up (both, P < 0.001) than did those in the low-NLR group. Univariate analysis showed revealed that NLR was significantly associated with relapse (odds ratio [OR] = 1.28, 95% confidence interval [CI]: 1.16–1.41, P < 0.001) and poor recovery (OR = 1.32, 95% CI: 1.20–1.46, P < 0.001), and these associations remained significant, even after multifactorial analysis (OR = 1.33, 95% CI: 1.11–1.59, P = 0.002; OR = 1.23, 95% CI: 1.06–1.43, P = 0.007, respectively). Stratified analysis showed that sex, platelet-to-lymphocyte ratio (PLR) level, and lymphocyte-to-monocyte technical ratio (LMR) level were strongly associated with relapse owing to elevated NLR; Kaplan-Meier survival curve analysis showed that the median time to relapse was significantly lower in the high-NLR group than in the low-NLR group (P < 0.001). A multivariate analysis showed a significant relationship between NLR level with relapse (HR = 1.07, 95%CI: 1.03–1.10, P = 0.001) and poor recovery (HR = 1.08, 95%CI: 1.04–1.11, P = 0.001). Conclusions NLR may be used as a prognostic indicator for first onset NMOSD, and a high NLR may be significantly associated with high relapse rates and poor recovery.

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