Comparison of relapse and treatment failure rates among patients with neuromyelitis optica: Multicenter study of treatment efficacy

Maureen A. Mealy, Dean Marko Wingerchuk, Jacqueline Palace, Benjamin M. Greenberg, Michael Levy

Research output: Contribution to journalArticle

113 Citations (Scopus)

Abstract

IMPORTANCE: Neuromyelitis optica (NMO) is an inflammatory disease of the optic nerves and spinal cord that leads to blindness and paralysis. Effective immunosuppression is the standard of care for relapse prevention. OBJECTIVE: To compare the relapse and treatment failure rates among patients receiving the 3 most common forms of immunosuppression for NMO: azathioprine, mycophenolate mofetil, and rituximab. DESIGN, SETTING, AND PARTICIPANTS: We performed a retrospective, multicenter analysis of relapses in 90 patients with NMO and NMO spectrum disorder treated with azathioprine, mycophenolate, and/or rituximab at the Mayo Clinic and the Johns Hopkins Hospital during the past 10 years. MAIN OUTCOME AND MEASURE: Annualized relapse rates. RESULTS: Rituximab reduced the relapse rate up to 88.2%, with 2 in 3 patients achieving complete remission. Mycophenolate reduced the relapse rate by up to 87.4%, with a 36% failure rate. Azathioprine reduced the relapse rate by 72.1% but had a 53% failure rate despite concurrent use of prednisone. CONCLUSIONS AND RELEVANCE: Initial treatment with rituximab, mycophenolate, and, to a lesser degree, azathioprine significantly reduces relapse rates in NMO and NMO spectrum disorder patients. Patients for whom initial treatment fails often achieve remission when treatment is switched from one to another of these drugs.

Original languageEnglish (US)
Pages (from-to)324-330
Number of pages7
JournalJAMA Neurology
Volume71
Issue number3
DOIs
StatePublished - Mar 2014

Fingerprint

Neuromyelitis Optica
Treatment Failure
Multicenter Studies
Recurrence
Azathioprine
Immunosuppression
Mycophenolic Acid
Optic Nerve Diseases
Blindness
Standard of Care
Secondary Prevention
Prednisone
Relapse
Treatment Efficacy
Paralysis
Spinal Cord
Therapeutics
Rituximab

ASJC Scopus subject areas

  • Arts and Humanities (miscellaneous)
  • Clinical Neurology

Cite this

Comparison of relapse and treatment failure rates among patients with neuromyelitis optica : Multicenter study of treatment efficacy. / Mealy, Maureen A.; Wingerchuk, Dean Marko; Palace, Jacqueline; Greenberg, Benjamin M.; Levy, Michael.

In: JAMA Neurology, Vol. 71, No. 3, 03.2014, p. 324-330.

Research output: Contribution to journalArticle

Mealy, Maureen A. ; Wingerchuk, Dean Marko ; Palace, Jacqueline ; Greenberg, Benjamin M. ; Levy, Michael. / Comparison of relapse and treatment failure rates among patients with neuromyelitis optica : Multicenter study of treatment efficacy. In: JAMA Neurology. 2014 ; Vol. 71, No. 3. pp. 324-330.
@article{72f20c5e9bd34433ba239b7b0f92db1f,
title = "Comparison of relapse and treatment failure rates among patients with neuromyelitis optica: Multicenter study of treatment efficacy",
abstract = "IMPORTANCE: Neuromyelitis optica (NMO) is an inflammatory disease of the optic nerves and spinal cord that leads to blindness and paralysis. Effective immunosuppression is the standard of care for relapse prevention. OBJECTIVE: To compare the relapse and treatment failure rates among patients receiving the 3 most common forms of immunosuppression for NMO: azathioprine, mycophenolate mofetil, and rituximab. DESIGN, SETTING, AND PARTICIPANTS: We performed a retrospective, multicenter analysis of relapses in 90 patients with NMO and NMO spectrum disorder treated with azathioprine, mycophenolate, and/or rituximab at the Mayo Clinic and the Johns Hopkins Hospital during the past 10 years. MAIN OUTCOME AND MEASURE: Annualized relapse rates. RESULTS: Rituximab reduced the relapse rate up to 88.2{\%}, with 2 in 3 patients achieving complete remission. Mycophenolate reduced the relapse rate by up to 87.4{\%}, with a 36{\%} failure rate. Azathioprine reduced the relapse rate by 72.1{\%} but had a 53{\%} failure rate despite concurrent use of prednisone. CONCLUSIONS AND RELEVANCE: Initial treatment with rituximab, mycophenolate, and, to a lesser degree, azathioprine significantly reduces relapse rates in NMO and NMO spectrum disorder patients. Patients for whom initial treatment fails often achieve remission when treatment is switched from one to another of these drugs.",
author = "Mealy, {Maureen A.} and Wingerchuk, {Dean Marko} and Jacqueline Palace and Greenberg, {Benjamin M.} and Michael Levy",
year = "2014",
month = "3",
doi = "10.1001/jamaneurol.2013.5699",
language = "English (US)",
volume = "71",
pages = "324--330",
journal = "JAMA Neurology",
issn = "2168-6149",
publisher = "American Medical Association",
number = "3",

}

TY - JOUR

T1 - Comparison of relapse and treatment failure rates among patients with neuromyelitis optica

T2 - Multicenter study of treatment efficacy

AU - Mealy, Maureen A.

AU - Wingerchuk, Dean Marko

AU - Palace, Jacqueline

AU - Greenberg, Benjamin M.

AU - Levy, Michael

PY - 2014/3

Y1 - 2014/3

N2 - IMPORTANCE: Neuromyelitis optica (NMO) is an inflammatory disease of the optic nerves and spinal cord that leads to blindness and paralysis. Effective immunosuppression is the standard of care for relapse prevention. OBJECTIVE: To compare the relapse and treatment failure rates among patients receiving the 3 most common forms of immunosuppression for NMO: azathioprine, mycophenolate mofetil, and rituximab. DESIGN, SETTING, AND PARTICIPANTS: We performed a retrospective, multicenter analysis of relapses in 90 patients with NMO and NMO spectrum disorder treated with azathioprine, mycophenolate, and/or rituximab at the Mayo Clinic and the Johns Hopkins Hospital during the past 10 years. MAIN OUTCOME AND MEASURE: Annualized relapse rates. RESULTS: Rituximab reduced the relapse rate up to 88.2%, with 2 in 3 patients achieving complete remission. Mycophenolate reduced the relapse rate by up to 87.4%, with a 36% failure rate. Azathioprine reduced the relapse rate by 72.1% but had a 53% failure rate despite concurrent use of prednisone. CONCLUSIONS AND RELEVANCE: Initial treatment with rituximab, mycophenolate, and, to a lesser degree, azathioprine significantly reduces relapse rates in NMO and NMO spectrum disorder patients. Patients for whom initial treatment fails often achieve remission when treatment is switched from one to another of these drugs.

AB - IMPORTANCE: Neuromyelitis optica (NMO) is an inflammatory disease of the optic nerves and spinal cord that leads to blindness and paralysis. Effective immunosuppression is the standard of care for relapse prevention. OBJECTIVE: To compare the relapse and treatment failure rates among patients receiving the 3 most common forms of immunosuppression for NMO: azathioprine, mycophenolate mofetil, and rituximab. DESIGN, SETTING, AND PARTICIPANTS: We performed a retrospective, multicenter analysis of relapses in 90 patients with NMO and NMO spectrum disorder treated with azathioprine, mycophenolate, and/or rituximab at the Mayo Clinic and the Johns Hopkins Hospital during the past 10 years. MAIN OUTCOME AND MEASURE: Annualized relapse rates. RESULTS: Rituximab reduced the relapse rate up to 88.2%, with 2 in 3 patients achieving complete remission. Mycophenolate reduced the relapse rate by up to 87.4%, with a 36% failure rate. Azathioprine reduced the relapse rate by 72.1% but had a 53% failure rate despite concurrent use of prednisone. CONCLUSIONS AND RELEVANCE: Initial treatment with rituximab, mycophenolate, and, to a lesser degree, azathioprine significantly reduces relapse rates in NMO and NMO spectrum disorder patients. Patients for whom initial treatment fails often achieve remission when treatment is switched from one to another of these drugs.

UR - http://www.scopus.com/inward/record.url?scp=84896801184&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84896801184&partnerID=8YFLogxK

U2 - 10.1001/jamaneurol.2013.5699

DO - 10.1001/jamaneurol.2013.5699

M3 - Article

C2 - 24445513

AN - SCOPUS:84896801184

VL - 71

SP - 324

EP - 330

JO - JAMA Neurology

JF - JAMA Neurology

SN - 2168-6149

IS - 3

ER -