Treatment Changes More Common in NMOSD Patients with Relapses

Research could help ID those whose lives may benefit from changes in treatment

Margarida Maia, PhD avatar

by Margarida Maia, PhD |

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People with neuromyelitis optica spectrum disorder (NMOSD) who experience relapses are three times more likely to change their treatment regimen than those who have no relapses, a study found.

Researchers also observed that people who experienced optic neuritis with or without brain symptoms, those with shorter disease duration, and people with a coexisting (comorbid) autoimmune disease also were more likely to make changes in treatment.

Optic neuritis is a common symptom of NMOSD that refers to inflammation of the optic nerve, the nerve that sends information from the eyes to the brain.

“Such findings may facilitate the identification of patients with NMOSD who are likely to benefit from treatment change to reduce relapse risk or disease burden and enhance the quality of life,” the researchers wrote.

The study, “Clinical and epidemiological correlates of treatment change in patients with NMOSD: insights from the CIRCLES cohort,” was published in the Journal of Neurology.

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NMOSD is characterized by the body’s own immune system mistakenly attacking cells of the spinal cord and optic nerve, although regions from the brain can also be damaged.

In most patients, NMOSD has a relapsing-remitting disease course, in which periods of symptom worsening called relapses are interspersed by periods of remission where symptoms ease or go away entirely.

Some relapses in NMOSD can be severe and cause lasting damage, but a number of therapies can help prevent future relapses from occurring.

Yet, factors that impact treatment decisions in NMOSD are not well understood, although “changing maintenance therapy in NMOSD is always an important consideration for patients with inadequate control of disease activity,” the researchers wrote.

To know more, a team of researchers in the U.S. examined data from people with NMOSD who participated in the Collaborative International Research in Clinical and Longitudinal Experience Study (CIRCLES) program, an observation study collecting standardized clinical data and biological samples from NMOSD patients over time.

A total of 542 patients with at least 60 days of follow-up data in CIRCLES were included in the analysis. Most (81.9%) had been diagnosed with the disease for one year or longer, and the majority were female (86.5%), white (57.4%), and positive for antibodies against the aquaporin 4 protein (83.9%). Their median follow-up was 2.22 years.

About one in four patients (28.2%) also had a concomitant autoimmune disease, such as lupus, Sjögren’s syndrome, rheumatoid arthritis, or myasthenia gravis. The majority of patients were receiving treatments that are commonly used off-label in NMOSD, including rituximab, mycophenolate mofetil, steroids, azathioprine, and tocilizumab.

Treatment changes

Over the course of the study, 133 patients (24.5%) changed their treatment at least once. People who experienced optic neuritis and/or symptoms related to brain damage were more likely to make changes in treatment, as were those who had the disease for less than one year or a comorbid autoimmune disease.

A total of 292 relapses were reported in 171 patients during the study. Those who experienced a relapse had a 2.91 times higher risk of changing their treatment compared with patients without relapses. People who reported more than 0.75 relapses per year, on average, before entering the study had their risk increased by 2.28 times.

The symptoms that appeared during a relapse also impacted treatment changes. For example, patients who experienced optic neuritis and/or symptoms related to brain damage had the highest risk of changing treatment — 5.49 times higher compared with patients without a relapse.

This was closely followed by relapses involving optic neuritis and transverse myelitis (spinal cord inflammation), without or without symptoms of brain involvement — who had a 5.38 higher risk.

The researchers also examined treatment changes in the 320 people received two or more doses of rituximab at some point during the study. In this group, 30.6% of patients experienced at least one relapse and only 14.1% changed their treatment.

“This finding suggests that patients on rituximab are less likely to change therapy than is the overall study population,” the researchers wrote.

Similar to previous results with all therapies, experiencing a relapse, reporting a mean annual relapse rate greater than 0.75, and having a comorbid autoimmune disease were all linked to a shorter time to first rituximab discontinuation.

“These findings may help facilitate identifying determinants or predictors of treatment change and aid in optimizing therapy to reduce disease burden and enhance quality of life in patients with NMOSD,” the researchers concluded.