吗替麦考酚酯治疗髓鞘少突胶质细胞糖蛋白抗体相关性疾病的长期疗效：一项前瞻性研究。
Long-term efficacy of mycophenolate mofetil in myelin oligodendrocyte glycoprotein antibody-associated disorders: A prospective study.
机构信息
From the Department of Neurology (S.L., H.R., Y.X., Y. Zhang, H.Y., Y. Zhu, B.P., L.C.), Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; Department of Epidemiology and Biostatistics Institute of Basic Medical Sciences (T.X.), Chinese Academy of Medical Sciences & School of Basic Medicine, Peking Union Medical College; Department of Neurology (W.Z., J.L., X.R., F.F.), Beijing Children's Hospital, Capital Medical University, National Center for Children's Health; Oumeng V Medical Laboratory (W.L.), Hangzhou; CAS Key Laboratory of Mental Health (J.W.), Institute of Psychology, Beijing, China Department of Psychology, University of Chinese Academy of Sciences; Department of Ophthalmology (Y. Zhong), Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences; and Neurosciences Center (L.C.), Chinese Academy of Medical Sciences, Beijing, China.
出版信息
Neurol Neuroimmunol Neuroinflamm. 2020 Mar 13;7(3). doi: 10.1212/NXI.0000000000000705. Print 2020 May.
OBJECTIVE
To investigate whether the use of mycophenolate mofetil (MMF) could reduce the relapse risk in patients with myelin oligodendrocyte glycoprotein (MOG)-immunoglobulin G (IgG)-associated disorders (MOGADs).
METHODS
This prospective observational cohort study included patients with MOGAD at Peking Union Medical College Hospital between January 1, 2017, and April 30, 2019. The patients were divided into 2 groups: those with (MMF+) or without (MMF-) MMF therapy. The primary outcome was relapse at follow-up. We used Cox proportional hazards models to calculate hazard ratios (HRs) for relapse.
RESULTS
Seventy-nine patients were included in our MOG cohort. Fifty (63.3%) were adults at index date, and 47 (59.5%) were women. Fifty-four (68.4%) were in the MMF+ group, and 25 (31.6%) were in the MMF- group. Clinical and demographic factors, MOG-IgG titer, and follow-up time (median, 472.5 days for MMF+, 261.0 days for MMF-) were comparable between the groups. Relapse rates were 7.4% (4/54) in the MMF+ group and 44.0% (11/25) in the MMF- group. Of all potential confounders, only the use of MMF was associated with reduced risk of relapse. The HR for relapse among patients in the MMF+ group was 0.14 (95% CI, 0.05-0.45) and was 0.08 (95% CI, 0.02-0.28) in a model adjusted for age, sex, disease course, and MOG-IgG titer. MMF therapy also remained associated with a reduced relapse risk in sensitivity analyses. Only one patient (1.9%) discontinued MMF therapy because of adverse effect.
CONCLUSIONS
These findings provide a clinical evidence that MMF immunosuppression therapy may prevent relapse in patients with MOGAD.
CLASSIFICATION OF EVIDENCE
This study provides class IV evidence that for patients with MOGAD, MMF reduces relapse risk.
目的
研究霉酚酸酯（MMF）的使用是否可以降低髓鞘少突胶质细胞糖蛋白（MOG）-免疫球蛋白 G（IgG）相关疾病（MOGAD）患者的复发风险。
方法
本前瞻性观察性队列研究纳入了 2017 年 1 月 1 日至 2019 年 4 月 30 日期间在北京协和医院就诊的 MOGAD 患者。患者分为接受（MMF+）或未接受（MMF-）MMF 治疗两组。主要结局为随访时的复发情况。我们使用 Cox 比例风险模型计算复发的风险比（HR）。
结果
本 MOG 队列纳入了 79 例患者。发病时 50 例（63.3%）为成年人，47 例（59.5%）为女性。54 例（68.4%）在 MMF+组，25 例（31.6%）在 MMF-组。两组的临床和人口统计学因素、MOG-IgG 滴度和随访时间（中位数，MMF+组为 472.5 天，MMF-组为 261.0 天）相似。MMF+组的复发率为 7.4%（4/54），MMF-组为 44.0%（11/25）。在所有潜在混杂因素中，只有 MMF 的使用与降低复发风险相关。在 MMF+组中，复发的 HR 为 0.14（95%CI，0.05-0.45），在调整年龄、性别、病程和 MOG-IgG 滴度后为 0.08（95%CI，0.02-0.28）。在敏感性分析中，MMF 治疗仍与降低复发风险相关。只有 1 例（1.9%）患者因不良反应停用 MMF 治疗。
结论
这些发现提供了临床证据表明，MMF 免疫抑制治疗可能预防 MOGAD 患者的复发。
证据分类
本研究提供了 IV 级证据，表明对于 MOGAD 患者，MMF 降低了复发风险。
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