Researchers demonstrated the long-term effectiveness of immunosuppressants in preventing relapse in neuromyelitis optica spectrum disorder (NMOSD) and published their results in the European Journal of Neurology.
They found significantly reduced relapse rates for up to 5 years of immunosuppressant treatment. However, a 77.5% rate of relapse after immunosuppressant withdrawal was also observed, and patients with longitudinal extensive transverse myelitis (LETM) were at a higher risk of relapse than other patients after discontinuation of immunosuppressants.
“This study aimed to explore changes in relapse risk based on [immunosuppressant] treatment duration and assess clinical outcomes and predictors of relapse following [immunosuppressant] discontinuation in patients with NMOSD,” the authors explained. “This study is expected to provide a critical clinical reference for establishing an individualized maintenance [immunosuppressant] treatment strategy for NMOSD.”
The research team assessed data on 343 patients with NMOSD at a Chinese center between January 2016 and December 2020. The primary outcome measures were changes in the risk of relapse depending on the duration of immunosuppressant treatment, clinical outcomes, and relapse predictors after immunosuppressant withdrawal.
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The results showed a reduced risk of relapse within 5 years of starting immunosuppressant treatment and a mild rebound risk after 5 years. In particular, rituximab reduced the relapse risk in NMOSD to approximately 0 within 3 years of starting treatment. After discontinuing immunosuppressants, the relapse rate was high at 77.5%; however, unlike other immunosuppressants, relapse was delayed after rituximab withdrawal. The presence of LETM was associated with a higher risk of relapse after immunosuppressant withdrawal.
The research team noted that only 32 patients underwent treatment with rituximab. Therefore, they recommend further studies on clinical outcomes after cessation of rituximab and other new medications such as tocilizumab and satralizumab, with the aim of helping clinicians develop individualized treatment strategies for patients with NMOSD.
Li R, Li C, Huang Q, et al. Immunosuppressant and neuromyelitis optica spectrum disorder: optimal treatment duration and risk of discontinuation. Eur J Neurol. Published online May 31, 2022. doi:10.1111/ene.15425