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Original research
Immunosuppressive therapy in elderly patients with neuromyelitis optica spectrum disorder: a retrospective multicentre study
  1. Ki Hoon Kim1,2,
  2. Yeon Hak Chung3,4,
  3. Ju-Hong Min3,
  4. Hee Jo Han5,
  5. Seung Woo Kim5,
  6. Ha Young Shin5,
  7. Young Nam Kwon5,6,
  8. Sung-Min Kim6,
  9. Young-Min Lim7,
  10. Hyunjin Kim7,
  11. Eun-Jae Lee7,
  12. Seong Ho Jeong2,
  13. Jae-Won Hyun1,
  14. Su-Hyun Kim1,
  15. Ho Jin Kim1
  1. 1Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang, Korea (the Republic of)
  2. 2Department of Neurology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea (the Republic of)
  3. 3Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)
  4. 4Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea (the Republic of)
  5. 5Department of Neurology, Yonsei University College of Medicine, Seoul, Korea (the Republic of)
  6. 6Department of Neurology, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
  7. 7Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (the Republic of)
  1. Correspondence to Dr Su-Hyun Kim, Neurology, Research Institute and Hospital of National Cancer Center, Goyang, Korea (the Republic of); herena20{at}ncc.re.kr

Abstract

Background The risk–benefit relationship of immunosuppressive therapies (ISTs) for elderly patients with neuromyelitis optica spectrum disorder (NMOSD) is not well established. This study aimed to investigate the safety and efficacy of IST in elderly patients with NMOSD.

Methods This retrospective study analysed IST efficacy and safety in 101 patients with aquaporin-4 antibody-positive NMOSD aged over 65 years, treated for at least 6 months at five Korean referral centres, focusing on relapse rates, infection events and discontinuation due to adverse outcomes.

Results The mean age at disease onset was 59.8 years, and female-to-male ratio was 4:1. Concomitant comorbidities at NMOSD diagnosis were found in 87 patients (86%). The median Expanded Disability Status Scale score at the initiation of IST was 3.5. The administered ISTs included azathioprine (n=61, 60%), mycophenolate mofetil (MMF) (n=48, 48%) and rituximab (n=41, 41%). Over a median of 5.8 years of IST, 58% of patients were relapse-free. The median annualised relapse rate decreased from 0.76 to 0 (p<0.001), and 81% experienced improved or stabilised disability. Patients treated with rituximab had a higher relapse-free rate than those treated with azathioprine or MMF (p=0.022). During IST, 21 patients experienced 25 severe infection events (SIEs) over the age of 65 years, and 3 died from pneumonia. 14 patients (14%) experienced 17 adverse events that led to switching or discontinuation of IST. When comparing the incidence rates of SIEs and adverse events, no differences were observed among patients receiving azathioprine, MMF and rituximab.

Conclusion In elderly patients with NMOSD, IST offers potential benefits in reducing relapse rates alongside a tolerable risk of adverse events.

  • IMMUNOLOGY
  • MULTIPLE SCLEROSIS

Data availability statement

Data are available upon reasonable request. The datasets generated and analysed in this study are available from the corresponding author upon reasonable request.

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Data availability statement

Data are available upon reasonable request. The datasets generated and analysed in this study are available from the corresponding author upon reasonable request.

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Footnotes

  • Contributors KHK—methodology, formal analysis, investigation, resources, writing (original draft, review and editing), visualisation. YHC—investigation, resources, writing (review and editing). J-HM—methodology, investigation, resources, writing (review and editing). HJH—investigation, resources. SWK—investigation, resources, writing (review and editing). HYS—methodology, investigation, resources, writing (review and editing). YNK—methodology, investigation, resources, writing (review and editing). S-MK— methodology, investigation, resources, writing (review and editing). Y-ML—investigation, resources, writing (review and editing). HK—investigation, resources, writing (review and editing). E-JL—methodology, investigation, resources, writing (review and editing). SHJ—formal analysis, visualisation. J-WH—methodology, investigation, resources, writing (review and editing). S-HK—conceptualisation, methodology, investigation, resources, writing (review and editing), supervision. HJK—conceptualisation, methodology, investigation, resources, writing (review and editing), supervision. S-HK is the guarantor of the study and accepts full responsibility for the work and the conduct of the study, had access to the data, and controlled the decision to publish.

  • Funding This work was supported by the National Research Foundation of Korea (grant no. NRF-2018R1A5A2023127).

  • Competing interests KHK, Y-ML, HK, YHC, HJH, SWK, SHJ, HYS and E-JL report no disclosures. S-HK has lectured, consulted and received honoraria from Bayer Schering Pharma, Biogen, Genzyme, Merck Serono and UCB; and received a grant from the National Research Foundation of Korea. J-WH has received a grant from the National Research Foundation of Korea. HJK received a grant from the National Research Foundation of Korea and research support from Aprilbio and Eisai; received consultancy/speaker fees from Alexion, Aprilbio, Altos Biologics, Biogen, Celltrion, Daewoong, Eisai, GC Pharma, Handok, Horizon Therapeutics, Kaigene, Kolon Life Science, MDimune, Mitsubishi Tanabe Pharma, Merck Serono, Novartis, Roche, Sanofi Genzyme, Teva-Handok and UCB; is a co-editor for the Multiple Sclerosis Journal and an associated editor for the Journal of Clinical Neurology. YNK has received a grant from the National Research Foundation of Korea, the Korea Health Industry Development Institute Research and Eisai; and also has lectured, consulted and received honoraria from Celltrion, Eisai, GC Pharma, Merck Serono, Roche and Sanofi Genzyme. J-HM is funded by and has received research support from the National Research Foundation of Korea (MIST and KHIDI) and SMC Research and Development Grant. She has lectured, consulted and received honoraria from Bayer Healthcare, Merck, Biogen Idec, Sanofi, UCB, Samsung Bioepis, Mitsubishi Tanabe, Celltrion, Roche, Janssen and AstraZeneca. S-MK has lectured, consulted and received honoraria from Bayer Schering Pharma, Genzyme, Merck Serono, Eisai and UCB; received a grant from the National Research Foundation of Korea and the Korea Health Industry Development Institute Research; and is an associate editor of the Journal of Clinical Neurology.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.