Chen Hongxi, Zhang Yan, Shi Ziyan, Feng Huiru, Yao Shaoli, Xie Jinglu, Zhou Hongyu
Department of Neurology, West China Hospital of Sichuan University, Chengdu, China.
Clin Neuropharmacol. 2016 Mar-Apr;39(2):81-7. doi: 10.1097/WNF.0000000000000131.
The aim of this study was to assess the efficacy and tolerability of mycophenolate mofetil (MMF) in neuromyelitis optica (NMO) or NMO spectrum disorder (NMOSD) in western China.
We enrolled 90 patients with NMO or NMOSD who had received MMF between January 1, 2010, and June 15, 2015.
Of 90 patients, 62 (4 men and 58 women; aged 44.6 [11.5] years) were included in the study. After being treated for a median of 1.5 years (range, 0.5-4.1 years), the median annualized relapse rate for these 62 patients decreased from 1.2 (range, 0.2-7.0) pre-MMF to 0 (range, 0-1.7) post-MMF (P = 0.000), and the median Expanded Disability Status Scale score decreased from 4 (range, 0.5-8.0) pre-MMF to 2 (range, 0.5-7.5) post-MMF (P = 0.000). Thirty-six of the 62 patients were relapse free during MMF treatment. In the Cox regression, none of the following were identified as risk factors: disease duration, pre-MMF annualized relapse rate and Expanded Disability Status Scale, sex, concurrent use of prednisolone during MMF treatment, previous use of other immunosuppressive therapies (other than chronic prednisolone), and abnormal autoantibodies (other than NMO-IgG). However, serum NMO-IgG positivity (hazard ratio [HR], 11.408; 95% confidence interval [CI], 1.330-97.833; P = 0.026) and older age at onset (HR, 0.957; 95% CI, 0.917-0.999; P = 0.043) were significant risk factors. Kaplan-Meier survival analysis indicated a lower risk of relapse during MMF treatment relative to the pre-MMF period (HR, 0.439; 95% CI, 0.272-0.707; P = 0.001). None of the 62 patients discontinued MMF because of adverse effects.
Mycophenolate mofetil is an effective and tolerable agent for reducing relapse and improving or stabilizing disabilities resulting from NMO or NMOSD.
本研究旨在评估霉酚酸酯（MMF）在中国西部视神经脊髓炎（NMO）或视神经脊髓炎谱系障碍（NMOSD）中的疗效和耐受性。
我们纳入了90例在2010年1月1日至2015年6月15日期间接受MMF治疗的NMO或NMOSD患者。
90例患者中，62例（4例男性和58例女性；年龄44.6[11.5]岁）纳入研究。在接受中位时间为1.5年（范围0.5 - 4.1年）的治疗后，这62例患者的年化复发率中位数从MMF治疗前的1.2（范围0.2 - 7.0）降至MMF治疗后的0（范围0 - 1.7）（P = 0.000），扩展残疾状态量表评分中位数从MMF治疗前的4（范围0.5 - 8.0）降至MMF治疗后的2（范围0.5 - 7.5）（P = 0.000）。62例患者中有36例在MMF治疗期间无复发。在Cox回归分析中，未发现以下因素为危险因素：疾病持续时间、MMF治疗前的年化复发率和扩展残疾状态量表、性别、MMF治疗期间同时使用泼尼松龙、既往使用其他免疫抑制疗法（慢性泼尼松龙除外）以及自身抗体异常（NMO - IgG除外）。然而，血清NMO - IgG阳性（风险比[HR]，11.408；95%置信区间[CI]，1.330 - 97.833；P = 0.026）和发病时年龄较大（HR，0.957；95%CI，0.917 - 0.999；P = 0.043）是显著的危险因素。Kaplan - Meier生存分析表明，与MMF治疗前相比，MMF治疗期间复发风险较低（HR，0.439；95%CI，0.272 - 0.707；P = 0.001）。62例患者中无一例因不良反应停用MMF。
霉酚酸酯是一种有效且耐受性良好的药物，可减少NMO或NMOSD导致的复发，并改善或稳定残疾状况。
