Long-term treatment response in Argentinian patients with Neuromyelitis Optica

MELAMUD L; RIVAROLA V; FERNANDEZ J; GARCEA O; CAPURRO C; VILLA A

Amsterdam

Congreso; 5th joint triennial congress of the european and americas committees for treatment and research in multiple sclerosis; 2011

european and americas committees for treatment and research in multiple sclerosis

Introduction: Treatment of Neuromyelitis Optica (NMO) usually includes immunosuppressant medication. However, controlled clinical trials are lacking, and patients often experience disease activity. Objetive: To analyse treatment response in Argentinian patients with NMO. Material and Methods: We reviewed 27 medical records of patients with relapsing NMO seen at the the Neuroinmmunology Clinic of the Ramos Mejia Hospital in Argentina from 2006 to 2011. NMO was diagnosed by the Wingerchuk´s criteria. Treatment efficacy was evaluated by analysis of relapse frequency and disability progression measured by the Expanded Disability Severity Scale (EDSS). Patients were divided in 2 groups according to treatments that were implemented along follow-up: patients treated with azathioprine solely o with prednisone (azathioprine group), and those who received other treatments ("other treatment" group). Results: Twenty one patients met the inclusion criteria, with a mean follow-up of 6.3 years (range, 2-15 years). Six patients were excluded because they have a follow-up time of less than 6 months. Forty-one treatments were implemented in 21 patients, which included intravenous cyclophosphamide; interferon beta; glatiramer acetate; mitoxantrone; intravenous immunoglobulin; prednisone; azathioprine solely or with prednisone and rituximab. Patients in the azathioprine group (ten) had a reduction in the number of relapses, from a mean (SD) of 3.3 (1.2) relapses pretreatment to 2.4 (2.3) after azathioprine implementation; their mean (SD) EDSS score also have a reduction after treatment from 4.75 (1.9) to 4.25 (2.1). In the "other treatment" group they are 11 patients, five of them had initially been treated with other therapies and later were given azathioprine with or without prednisone. These subgroup after azathioprine had a reduction of a mean (SD) relapses and EDSS from 4 (1.4) to 2.4 (2.8) and 4.7 (2.2) to 4.3 (1.7) respectively. The others patients of this group despite multiple therapies at last visit: 3 were receiving rituximab, 2 prednisone solely and 1 glatiramer acetate. Conclusions: In this retrospective case series azathioprine as monotherapy or with prednisone appears to reduce the frequency of attacks with stabilization in disability. Prospective studies in a large sample, focusing on prognostic factors and treatment responses should be performed.