Department of Neurology, West China Hospital, Sichuan University, Chengdu, China.
Mental Health Centre and Psychiatric Laboratory, West China Hospital, Sichuan University, Chengdu, China.
Front Immunol. 2022 Jul 26;13:953993. doi: 10.3389/fimmu.2022.953993. eCollection 2022.
Immunotherapy has been shown to reduce relapses in patients with myelin oligodendrocyte glycoprotein antibody-associated disorder (MOG-AD); however, the superiority of specific treatments remains unclear.
To identify the efficacy and tolerability of different treatments for MOG-AD.
Systematic search in Pubmed, Embase, Web of Science, and Cochrane Library databases from inception to March 1, 2021, were performed. Published articles including patients with MOG-AD and reporting the efficacy or tolerability of two or more types of treatment in preventing relapses were included. Reported outcomes including incidence of relapse, annualized relapse rate (ARR), and side effects were extracted. Network meta-analysis with a random-effect model within a Bayesian framework was conducted. Between group comparisons were estimated using Odds ratio (OR) or mean difference (MD) with 95% credible intervals (CrI).
Twelve studies that compared the efficacy of 10 different treatments in preventing MOG-AD relapse, including 735 patients, were analyzed. In terms of incidence of relapse, intravenous immunoglobulins (IVIG), oral corticosteroids (OC), mycophenolate mofetil (MMF), azathioprine (AZA), and rituximab (RTX) were all significantly more effective than no treatment (ORs ranged from 0.075 to 0.34). On the contrary, disease-modifying therapy (DMT) (OR=1.3, 95% CrI: 0.31 to 5.0) and tacrolimus (TAC) (OR=5.9, 95% CrI: 0.19 to 310) would increase the incidence of relapse. Compared with DMT, IVIG significantly reduced the ARR (MD=-0.85, 95% CrI: -1.7 to -0.098). AZA, MMF, OC and RTX showed a trend to decrease ARR, but those results did not reach significant differences. The combined results for relapse rate and adverse events, as well as ARR and adverse events showed that IVIG and OC were the most effective and tolerable therapies.
Whilst DMT should be avoided, IVIG and OC may be suited as first-line therapies for patients with MOG-AD. RTX, MMF, and AZA present suitable alternatives.
免疫疗法已被证明可减少髓鞘少突胶质细胞糖蛋白抗体相关性疾病（MOG-AD）患者的复发；然而，特定治疗的优越性仍不清楚。
确定不同治疗方法治疗 MOG-AD 的疗效和耐受性。
对 Pubmed、Embase、Web of Science 和 Cochrane Library 数据库进行系统检索，检索时间从建库至 2021 年 3 月 1 日。纳入包括 MOG-AD 患者且报告两种或两种以上治疗方法预防复发的疗效或耐受性的研究。提取复发率、年复发率（ARR）和不良反应等报告结果。采用贝叶斯框架内随机效应模型的网络荟萃分析。使用优势比（OR）或均数差值（MD）及其 95%可信区间（CrI）对组间比较进行估计。
纳入了 12 项比较 10 种不同治疗方法预防 MOG-AD 复发的疗效的研究，共纳入 735 例患者。在复发率方面，静脉注射免疫球蛋白（IVIG）、口服皮质类固醇（OC）、吗替麦考酚酯（MMF）、硫唑嘌呤（AZA）和利妥昔单抗（RTX）均明显优于未治疗组（OR 范围为 0.075 至 0.34）。相反，疾病修正治疗（DMT）（OR=1.3，95% CrI：0.31 至 5.0）和他克莫司（TAC）（OR=5.9，95% CrI：0.19 至 310）会增加复发率。与 DMT 相比，IVIG 显著降低了 ARR（MD=-0.85，95% CrI：-1.7 至 -0.098）。AZA、MMF、OC 和 RTX 显示出降低 ARR 的趋势，但未达到显著差异。复发率和不良反应、ARR 和不良反应的综合结果表明，IVIG 和 OC 是最有效和耐受的治疗方法。
尽管应避免使用 DMT，但 IVIG 和 OC 可能适合作为 MOG-AD 患者的一线治疗方法。RTX、MMF 和 AZA 是合适的替代方法。
