Treatment with azathioprine (AZA) or tocilizumab (TCZ) both can reduce the number of relapses and potentially improve disability in patients with neuromyelitis optica spectrum disorder (NMOSD), according to a review and meta-analysis published in Medicine.

The meta-analysis showed that the annualized relapse rate (ARR) was significantly reduced from baseline during treatment with AZA and treatment with TCZ. The standardized mean difference (SMD) of ARR from baseline to after treatment was -1.01 (P < .001) for AZA and -1.27 (P =.039) for TCZ. When comparing the 2 treatment methods, TCZ was found to reduce ARR more significantly than AZA (P =.0314).

Read more about NMOSD treatment

Continue Reading

“The results of this study showed that the treatment of NMOSD patients with AZA and TCZ are associated with decreased number of relapses and disability improvement as well. In addition, compared with AZA, TCZ more significantly reduce ARR,” the study’s authors said.

In terms of changes in expanded disability status scale (EDSS) scores, AZA showed a statistically significant reduction of -.40 (P <.001). While TCZ also showed a reduction in EDSS scores from baseline (-.84), the results were not significant (P =.076). The authors hypothesized that this lack of significance may be due to the small sample size included in the study.

A total of 27 studies were included in the meta-analysis resulting in a pool of 978 patients with NMOSD. Of these patients, 148 received TCZ (136 women and 12 men) and the remaining 930 patients received AZA (802 women and 128 men). The mean age of patients who received TCZ was 42.3 ± 14.1 years compared to a mean age of 7.5 ± 11.8 years for the AZA patients.

Of the TCZ patients, 127 were seropositive for aquaporin-4 (AQP4) antibodies which accounted for 85.8% of the patients. In the AZA group, 363 patients were seropositive for AQP4 antibodies, while the antibody status of 406 patients was unknown.


Tang Q, Yao M, Huang Y, et al. A comparison of the efficacy of tocilizumab versus azathioprine for neuromyelitis optica spectrum disorder: a study protocol for systematic review and meta-analysis. Medicine. Published online January 27, 2023. doi:10.1097/MD.0000000000032748