Efficacy Of Azathioprine,mycophenolate Mofetil And Rituximab In The Treatment Of Neuromyelitis Optica Spectrum Disorder And Analysis Of Prognostic Factors

Objective: We aimed to compare the efficacies of the immunosuppressants most commonly prescribed for patients with neuromyelitis optica spectrum disorder(NMOSD).We also analyzed the predictors which might be associated with relapse and disability in NMOSD.Methods: In this retrospective study,NMOSD patients treated with Azathioprine(AZA),Mycophenolate Mofetil(MMF)and Rituximab(RTX)were included.The annual relapse rate(ARR)and the incidence rates of adverse event were compared.The potential predictors of NMOSD relapse and disability were calculated by Cox proportional-hazards model.Results: A total of 83 patients were finally included.The median treatment time of AZA group(n=34),MMF group(n=20)and RTX group(n=29)were 19.5,15.5 and 12 months respectively.ARR of the three groups reduced significantly after treatment.In the three groups,55.9%,50% and 79.3% of patients were free from relapse respectively,and no significant difference was found among the three groups.During the treatment,32.4%,15% and 24.1% of patients in AZA group,MMF group and RTX group experienced adverse events respectively.Additionally,the multivariate Cox analyses indicated that history of a severe attack and disease duration were associated with risk of relapse after immunotherapy.Late-onset(?50 years old)NMOSD patients were probably more susceptible to motor disability,and those with optic neuritis at onset were more likely to develop visual disability.Conclusions: AZA,MMF and low-dose RTX were all effective in reducing relapse rate in NMOSD.The age of onset,disease duration,history of severe attack and symptom of onset might be important prognostic predictors in NMOSD.