Department of Anesthesiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.
Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.
Front Immunol. 2024 Nov 1;15:1458556. doi: 10.3389/fimmu.2024.1458556. eCollection 2024.
The impact of early intervention with immunosuppressive treatment (IST) in anti-Aquaporin4-antibody (AQP4-ab) seropositive neuromyelitis optica spectrum disorder (NMOSD) has not been thoroughly evaluated.
This study aims to assess the effects of early IST intervention in patients with NMOSD.
This retrospective cohort study included 174 treatments from 137 NMOSD patients seropositive for AQP4-antibody, treated with ISTs such as rituximab, mycophenolate mofetil, azathioprine, or tacrolimus. Multiple statistical analyses, including regression discontinuity design (RDD), kaplan-meier analyze, Cox proportional hazards regression model, were employed to evaluate the effects of early IST intervention on annualized relapse rate (ARR) change, Expanded Disability Status Scale (EDSS) change, and time to next relapse.
A total of 174 treatments from 137 patients were analyzed. Patients exhibited significant improvement in ARR[1.95 vs.0, IQR (0.70-6.0 vs. 0-0.42), p<0.001] and EDSS [3.0 vs. 2.5, IQR (2.0-4.0 vs. 1.0-3.0) p<0.001]after IST, although the ARR change was not significant in patients treated with TAC. Early IST initiation was associated with greater improvements in both ARR and EDSS compared to later initiation. RDD analysis demonstrated a time-dependent effect of ARR-change, indicating greater efficacy with early IST intervention.
Early intervention with ISTs in AQP4-antibody-positive NMOSD patients is associated with better outcomes in terms of reducing relapse rate and improving disability. These findings underscore the importance of early treatment in NMOSD.
早期免疫抑制治疗（IST）对水通道蛋白 4 抗体（AQP4-ab）阳性视神经脊髓炎谱系疾病（NMOSD）的影响尚未得到充分评估。
本研究旨在评估 NMOSD 患者早期 IST 干预的效果。
这是一项回顾性队列研究，纳入了 137 例 AQP4 抗体阳性 NMOSD 患者的 174 例治疗，这些患者接受了利妥昔单抗、霉酚酸酯、硫唑嘌呤或他克莫司等 IST 治疗。采用回归不连续设计（RDD）、Kaplan-Meier 分析、Cox 比例风险回归模型等多种统计分析方法，评估早期 IST 干预对年复发率（ARR）变化、扩展残疾状况量表（EDSS）变化和复发时间的影响。
共分析了 137 例患者的 174 例治疗。IST 后，ARR[1.95 比 0，IQR（0.70-6.0 比 0-0.42），p<0.001]和 EDSS[3.0 比 2.5，IQR（2.0-4.0 比 1.0-3.0），p<0.001]均有显著改善，但 TAC 治疗患者的 ARR 变化不显著。与晚期 IST 相比，早期 IST 起始治疗在 ARR 和 EDSS 方面均有更大的改善。RDD 分析表明 ARR 变化存在时间依赖性效应，提示早期 IST 干预具有更好的疗效。
AQP4-ab 阳性 NMOSD 患者早期 IST 干预与降低复发率和改善残疾有关，提示早期治疗对 NMOSD 具有重要意义。
