Carnero Contentti Edgar, López Pablo A, Criniti Juan, Pettinicchi Juan Pablo, Cristiano Edgardo, Patrucco Liliana, Bribiesca Contreras Elisa, Gómez-Figueroa Enrique, Flores-Rivera José, Correa-Díaz Edgar Patricio, Toral Granda Ana María, Ortiz Yepez María Angelica, Gualotuña Pachacama Wilson Alfredo, Piedra Andrade Jefferson Santiago, Galleguillos Lorna, Tkachuk Verónica, Nadur Débora, Daccach Marques Vanessa, Soto de Castillo Ibis, Casas Magdalena, Cohen Leila, Alonso Ricardo, Caride Alejandro, Lana-Peixoto Marco, Rojas Juan Ignacio
Neuroimmunology Unit, Department of Neuroscience, Hospital Alemán, Buenos Aires, Argentina.
Neuroimmunology Unit, Department of Neuroscience, Hospital Alemán, Buenos Aires, Argentina.
Mult Scler Relat Disord. 2023 Apr;72:104611. doi: 10.1016/j.msard.2023.104611. Epub 2023 Mar 8.
Optic neuritis (ON) can be an initial manifestation of neuromyelitis optica spectrum disorder (NMOSD) associated with aquaporin 4-antibody (AQP4-Ab) or myelin oligodendrocyte glycoprotein antibody (MOG-Ab)-associated disease (MOGAD). Additionally, both diseases may have overlapping paraclinical and radiological features. These diseases may have different outcomes and prognoses. We aimed to compare clinical outcomes and prognostic features of patients with NMOSD and MOGAD presenting ON as first attack, from different ethnic groups in Latin America.
We conducted a retrospective observational multicenter study in patients from Argentina (n = 61), Chile (n = 18), Ecuador (n = 27), Brazil (n = 30), Venezuela (n = 10) and Mexico (n = 49) with MOGAD or NMOSD related ON. Predictors of disability outcomes at last follow-up, namely visual disability (Visual Functional System Score ≥4), motor disability (permanent inability to walk further than 100 m unaided) and wheelchair dependence based on EDSS score were evaluated.
After a mean disease duration of 42.7 (±40.2) months in NMOSD and 19.7 (±23.6) in MOGAD, 55% and 22% (p>0.001) experienced permanent severe visual disability (visual acuity from 20/100 to 20/200), 22% and 6% (p = 0.01) permanent motor disability and 11% and 0% (p = 0.04) had become wheelchair dependent, respectively. Older age at disease onset was a predictor of severe visual disability (OR=1,03 CI95%1.01-1.05, p = 0.03); older age at disease onset (OR=1,04 CI95%1.01-1.07, p = 0.01), higher number of relapses (OR=1,32 CI95%1.02-1.71, p = 0.03) and rituximab treatment (OR=0,36 CI95%0.14-0.90, p = 0.02) were predictors of permanent motor disability, whereas ON associated with myelitis at disease onset was a predictor of wheelchair dependency (OR=4,16, CI95%1.23-14.08, p = 0,02) in NMOSD patients. No differences were found when evaluating distinct ethnic groups (Mixed vs. Caucasian vs. Afro-descendant) CONCLUSIONS: NMOSD was associated with poorer clinical outcomes than MOGAD. Ethnicity was not associated with prognostic factors. Distinct predictors of permanent visual and motor disability and wheelchair dependency in NMOSD patients were found.
视神经炎（ON）可能是视神经脊髓炎谱系障碍（NMOSD）的初始表现，NMOSD与水通道蛋白4抗体（AQP4-Ab）或髓鞘少突胶质细胞糖蛋白抗体（MOG-Ab）相关疾病（MOGAD）有关。此外，这两种疾病可能具有重叠的副临床和放射学特征。这些疾病可能有不同的结局和预后。我们旨在比较拉丁美洲不同种族中以ON为首发症状的NMOSD和MOGAD患者的临床结局和预后特征。
我们对来自阿根廷（n = 61）、智利（n = 18）、厄瓜多尔（n = 27）、巴西（n = 30）、委内瑞拉（n = 10）和墨西哥（n = 49）的与MOGAD或NMOSD相关的ON患者进行了一项回顾性观察性多中心研究。评估了最后一次随访时残疾结局的预测因素，即视力残疾（视觉功能系统评分≥4）、运动残疾（无法独立行走超过100米）和基于扩展残疾状态量表（EDSS）评分的轮椅依赖情况。
NMOSD患者的平均病程为42.7（±40.2）个月，MOGAD患者为19.7（±23.6）个月，分别有55%和22%（p>0.001）出现永久性严重视力残疾（视力从20/100至20/200），22%和6%（p = 0.01）出现永久性运动残疾，11%和0%（p = 0.04）需要依赖轮椅。发病时年龄较大是严重视力残疾的预测因素（OR = 1.03，95%CI 1.01 - 1.05，p = 0.03）；发病时年龄较大（OR = 1.04，95%CI 1.01 - 1.07，p = 0.01）、复发次数较多（OR = 1.32，95%CI 1.02 - 1.71，p = 0.03）和利妥昔单抗治疗（OR = 0.36，95%CI 0.14 - 0.90，p = 0.02）是永久性运动残疾的预测因素，而发病时与脊髓炎相关的ON是NMOSD患者轮椅依赖的预测因素（OR = 4.16，95%CI 1.23 - 14.08，p = 0.02）。在评估不同种族（混血、白种人和非裔后裔）时未发现差异。结论：与MOGAD相比，NMOSD的临床结局较差。种族与预后因素无关。发现了NMOSD患者永久性视力和运动残疾以及轮椅依赖的不同预测因素。
