Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Division of Neurology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkok Noi, Bangkok, 10700, Thailand.
Sci Rep. 2020 Oct 7;10(1):16727. doi: 10.1038/s41598-020-73882-8.
Mycophenolate mofetil (MMF) is an immunosuppressive agent (IS) which is widely prescribed in neuromyelitis optica spectrum disorder (NMOSD) patients. We aim to assess the efficacy and safety of MMF in controlling relapse and disease severity. Eligible studies obtained from the EMBASE and Ovid MEDLINE databases were studies of NMOSD patients treated with MMF, which reported treatment outcomes as Annualized Relapse Rate (ARR) or Expanded Disability Status Scale (EDSS) before and after treatment. Fifteen studies included 1047 patients, of whom 915 (87.4%) were aquaporin-4 immunoglobulin seropositive. The total number of patients that received MMF was 799. A meta-analysis on ARR was conducted in 200 patients from 4 studies and on EDSS in 158 patients from 3 studies. The result showed a significant improvement with a mean reduction of 1.13 [95% confidence interval (CI) 0.60-1.65] in ARR, and a mean reduction of 0.85 (95% CI 0.36-1.34) in EDSS after MMF therapy. Adverse events occurred in 106 (17.8%) of 594 patients during MMF therapy. This systematic review and meta-analysis showed that using MMF as a preventive therapy in NMOSD patients can significantly reduce relapse rates and improve disease severity with acceptable tolerability.
霉酚酸酯（MMF）是一种免疫抑制剂（IS），广泛用于视神经脊髓炎谱系疾病（NMOSD）患者。我们旨在评估 MMF 控制复发和疾病严重程度的疗效和安全性。从 EMBASE 和 Ovid MEDLINE 数据库中获得的合格研究是用 MMF 治疗 NMOSD 患者的研究，这些研究报告了治疗前后的年复发率（ARR）或扩展残疾状况量表（EDSS）作为治疗结果。15 项研究纳入了 1047 例患者，其中 915 例（87.4%）为水通道蛋白-4 免疫球蛋白阳性。共纳入 799 例接受 MMF 治疗的患者。对 4 项研究中的 200 例患者进行了 ARR 荟萃分析，对 3 项研究中的 158 例患者进行了 EDSS 荟萃分析。结果显示，ARR 显著改善，平均降低 1.13 [95%置信区间（CI）0.60-1.65]，EDSS 平均降低 0.85（95%CI 0.36-1.34）。在 MMF 治疗期间，594 例患者中有 106 例（17.8%）发生不良反应。本系统评价和荟萃分析显示，在 NMOSD 患者中使用 MMF 作为预防治疗可显著降低复发率，改善疾病严重程度，且耐受性可接受。
