Nuffield Department of Clinical Neurosciences, Oxford University, John Radcliffe Hospital, Oxford, UK.
Alexion Pharmaceutical, 55 Cambridge Parkway (Suite 800), Cambridge, MA 02142, USA.
Mult Scler Relat Disord. 2016 May;7:21-5. doi: 10.1016/j.msard.2016.02.014. Epub 2016 Feb 16.
Neuromyelitis optica (NMO) is a rare antibody-mediated CNS disease characterised by disabling relapses leading to high morbidity and mortality. Understanding relapse activity and severity is important for treatment decisions and clinical trial design. We assessed (1) whether clinical and demographic factors associate with different relapse rates and (2) the relative impact of immunosuppressive treatments on relapse rates and on attack-related residual disability.
Clinical, demographic and treatment data were prospectively collected from 79 consecutive aquaporin 4 antibody positive patients seen in the nationally commissioned Oxford NMO service. The influence of clinical features on annualised relapse rates (using multiple regression) and the effect of immunosuppression on relapse-associated residual disability for transverse myelitis and optic neuritis attacks (using a mixed effect model) were analysed.
The mean annualised relapse rate was 0.93. Relapse rates were significantly higher in Afro-Caribbeans, children and in those of shorter disease duration. Relapse rates reduced on treatment (from 0.87 to 0.42). Delay to first treatment did not influence eventual on-treatment relapse rate. Immunosuppressive treatment significantly reduced the residual disability from ON (p<0.01), and TM (p=0.029) attacks.
Relapse rates in NMO are influenced by multiple factors, including age, ethnicity and disease duration. Current immunosuppressive treatments reduce but do not abolish relapses, however, they appear to additionally lessen the chronic disabling effect of a relapse.
视神经脊髓炎（NMO）是一种罕见的以抗体介导的中枢神经系统疾病，其特征为致残性复发，导致高发病率和死亡率。了解复发活动和严重程度对于治疗决策和临床试验设计很重要。我们评估了（1）临床和人口统计学因素是否与不同的复发率相关，以及（2）免疫抑制治疗对复发率和与攻击相关的残留残疾的相对影响。
从全国委托的牛津 NMO 服务中连续观察到的 79 例水通道蛋白 4 抗体阳性患者中前瞻性地收集了临床、人口统计学和治疗数据。使用多元回归分析了临床特征对年化复发率的影响，以及使用混合效应模型分析了免疫抑制对横贯性脊髓炎和视神经炎攻击相关残留残疾的影响。
平均年化复发率为 0.93。非裔加勒比人、儿童和疾病持续时间较短的患者复发率明显较高。治疗后复发率降低（从 0.87 降至 0.42）。首次治疗的延迟并未影响最终治疗中的复发率。免疫抑制治疗显著降低了 ON（p<0.01）和 TM（p=0.029）攻击的残留残疾。
NMO 的复发率受到多种因素的影响，包括年龄、种族和疾病持续时间。目前的免疫抑制治疗可减少复发，但不能完全消除复发，然而，它们似乎还可以减轻复发的慢性致残影响。
