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Mult Scler. 2017 Sep;23(10):1377-1384. doi: 10.1177/1352458516678474. Epub 2016 Nov 25.

Effectiveness of mycophenolate mofetil as first-line therapy in AQP4-IgG, MOG-IgG, and seronegative neuromyelitis optica spectrum disorders.

Author information

1
Service de Neurologie A and Eugène Devic EDMUS Foundation against Multiple Sclerosis, Observatoire Français de la Sclérose en Plaques (OFSEP), Hôpital Neurologique Pierre Wertheimer-GHE, Hospices Civils de Lyon, Bron, France/Department of Neurology, Hôpital Dupuytren, Limoges, France.
2
Department of Neurology, and INSERM CIC-1434, CHU de Strasbourg, Strasbourg, France.
3
Department of Neurology, Hôpital Pitié-Salpêtrière, Paris, France.
4
Clinique Neurologique, University of Lille, Lille, France.
5
Department of Neurology, Hôpital Timone, Marseille, France.
6
Department of Neurology, University Hospital of Nantes, Nantes, France.
7
Department of Neurology, University Hospital of Rouen, Rouen, France.
8
Department of Neurology, and INSERM-CHU CIC-P 0005, CHU de Bordeaux, Bordeaux, France.
9
Department of Neurology, University Hospital of Saint-Etienne, Saint-Etienne, France.
10
Department of Neurology, University Hospital of Montpellier, Montpellier, France.
11
Department of Neurology, University Hospital of Dijon, Dijon, France.
12
Department of Neurology, University Hospital of Purpan, Toulouse, France.
13
Department of Neurology, Hopital Tenon, Paris, France.
14
Department of Neurology and INSERM CIC-1434, CHU de Strasbourg, France.
15
Service de Neurologie A and Eugène Devic EDMUS Foundation against Multiple Sclerosis, Observatoire Français de la Sclérose en Plaques (OFSEP), Hôpital Neurologique Pierre Wertheimer-GHE, Hospices Civils de Lyon, Bron, France/Lyon's Neuroscience Research Center, Team ONCOFLAM, Inserm U 1028/CNRS 5292, Lyon, France Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France.

Abstract

OBJECTIVE:

To evaluate the effectiveness and tolerance of mycophenolate mofetil (MMF) as a first-line treatment in neuromyelitis optica spectrum disorder (NMOSD).

METHODS:

In all, 67 NMOSD patients treated by MMF as first-line therapy, from the NOMADMUS cohort were included. A total of 65 fulfilled 2015 NMOSD criteria, and 5 were myelin oligodendrocyte glycoprotein (MOG)-immunoglobulin G (IgG) positive. Effectiveness was evaluated on percentage of patients continuing MMF, percentage of patients free of relapse, pre- and post-treatment change in the annualized relapse rate (ARR), and Expanded Disability Status Scale (EDSS).

RESULTS:

Among 67 patients, 40 (59.7%) continued treatment till last follow-up. A total of 33 (49.3%) were relapse-free. The median ARR decreased from one pre-treatment to zero post-treatment. Of 53 patients with complete EDSS data, the score improved or stabilized in 44 (83%; p < 0.05). Effectiveness was observed in aquaporin-4 (AQP4)-IgG (57.8% continued treatment, 46.7% relapse-free), MOG-IgG (3/5 continued treatment, 4/5 relapse-free), and seronegative NMOSD (64.7% continued treatment, 61.3% relapse-free). In 16 patients with associated steroids, 13 (81.2%) continued MMF till last follow-up versus 15 of 28 (53.6%) in the non-steroid group. Nine patients discontinued treatment for tolerability purpose.

CONCLUSION:

MMF showed effectiveness and good tolerability as a first-line therapy in NMOSD, whatever the AQP4-IgG status. Concomitant use of oral steroids at start could limit the risk of treatment failure.

KEYWORDS:

Aquaporin-4; myelin oligodendrocyte glycoprotein; neuromyelitis optica; treatment response

PMID:
27885065
DOI:
10.1177/1352458516678474
[Indexed for MEDLINE]

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