Highlights
- •Neuromyelitis optica is a serious autoimmune disease of the central nervous system.
- •Rituximab, mycophenolate mofetil, azathioprine can effectively treat the disease.
- •RTX significantly reduced ARR ratio compared with the other two drugs.
Abstract
Background
Neuromyelitis optica spectrum disorder (NMOSD) is an inflammatory disease of the central
nervous system, which mainly involves the optic nerve and spinal cord. Frequent relapse
can accumulate the degree of disability. At present, the main treatment options are
immunosuppressants and blood purification. The first-line immunosuppressants for NMOSD
are mainly rituximab (RTX), mycophenolate mofetil (MMF) and azathioprine (AZA). Therefore,
we designed this systematic review and meta-analysis to evaluate the safety and effect
of the above three drugs in the treatment of NMOSD patients.
Methods
The following Medical Subject Heading (MeSH) and related entry terms are used to search
English literature in PubMed, MEDLINE and CENTRAL databases, respectively. MeSH include:
Neuromyelitis optic and Rituximab or Azathioprine or Mycophenolate Mofetil; entry
terms include: NMO Spectrum Disorder, NMO Spectrum Disorders, Neuromyelitis Optica
(NMO) Spectrum Disorder, Neuromyelitis Optica Spectrum Disorders, Devic Neuromyelitis
Optica, Neuromyelitis Optica, Devic, Devic's Disease, Devic Syndrome, Devic's Neuromyelitis
Optica, Neuromyelitis Optica (NMO) Spectrum Disorders, CD20 Antibody, Rituximab CD20
Antibody, Mabthera, IDEC-C2B8 Antibody, GP2013, Rituxan, Mycophenolate Mofetil, Mofetil,
Mycophenolate, Mycophenolic Acid, Morpholinoethyl Ester, Cellcept, Mycophenolate Sodium,
Myfortic, Mycophenolate Mofetil Hydrochloride, Mofetil Hydrochloride, Mycophenolate,
RS 61443, RS-61443, RS61443, azathioprine sodium, azathioprine sulfate (note: literature
retrieval operators “AND” “OR” “NOT” are used to link MeSH with Entry Terms.)
The literature search found a total of 3058 articles about rituximab, mycophenolate
mofetil and azathioprine in the treatment of NMOSD, 63 of which were included in this
study after a series of screening.
Results
930,933,732 patients with NMOSD were enrolled, who had been treated with MMF, AZA
and RTX, respectively. The pooled standardized mean difference (SMD) of EDSS before
and after RTX treated was −0.58 (95%CI: −0.72, −0.44) (I2 = 0%, p = 0.477), before and after MMF treated was −0.47 (95%CI: −0.73, −0.21) (I2 = 85.6%, p<0.001), before and after AZA treated was −0.41 (95%CI: −0.60, −0.23) (I2 = 65.4%, p<0.001). there was no significant difference in the effect of the three drugs on reducing
EDSS scores (RTX vs MMF, p = 0.522; RTX vs AZA, p = 0.214; MMF vs AZA, p = 0.732). The pooled standardized mean difference (SMD) of ARR before and after RTX
treated was −1.45 (95%CI: −1.72, −1.18) (I2 = 72.4%, p<0.001), before and after MMF treated was −1.14 (95%CI: −1.31, −0.97) (I2 = 54.5%, p<0.001), before and after AZA treated was −1.11 (95%CI: −1.39, −0.83) (I2 = 83.4%, p<0.001). RTX significantly reduced ARR compared with the other two drugs (RTX vs MMF,
p = 0.039; RTX vs AZA, p = 0.049; MMF vs AZA, p = 0.436).
Conclusion
The results of this systematic review and meta-analysis showed that the treatment
of NMOSD patients with RTX, MMF and AZA is associated with decreased number of relapses
and disability improvement as well, and there was no significant difference in the
effect of the three drugs on reducing EDSS scores, but RTX significantly reduced ARR
compared with the other two drugs
Key words
Abbreviations:
AQP4-Ab (aquaporin-4 autoantibody), ARR (annualized relapse rate), EDSS (Expanded Disability Status Scale), SD (standard deviation), MeSH (Medical Subject Heading), NMO (neuromyelitis optica), RCT (randomized clinical trial), RTX (rituximab)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: December 16, 2021
Accepted:
December 11,
2021
Received in revised form:
November 28,
2021
Received:
September 10,
2021
Identification
Copyright
© 2021 Published by Elsevier B.V.
