Treatment strategies and responses for attacks of neuromyelitis optica spectrum disorder [JNS462 Editor's Choice]

• We evaluated 120 NMOSD patients who experienced 250 relapses and received 248 treatments.
• The most common treatment was IV methylprednisolone (78.6%), followed by plasmapheresis (16.9%).
• Younger age and a short delay to start treatment were independent predictors of a “good” response.

Abstract

Aim

We aimed to assess the treatment strategies utilized in patients with neuromyelitis optica spectrum disorder (NMOSD) experiencing relapses, including their frequency, types, and response after 6 months based on the Expanded Disability Status Scale (EDSS) score.

Method

We conducted a retrospective study involving NMOSD patients from the Argentinean MS and NMOSD registry (RelevarEM, NCT 03375177). Treatment response at 6 months was categorized as “good” if the EDSS score decreased by ≥1 point after a nadir EDSS score ≤ 3, or by ≥2 points after a nadir EDSS score > 3, “poor” if the EDSS score decrease was slighter, and as “absent” if the EDSS score remained unchanged or worsened.

Results

We included 120 NMOSD patients (seropositive N = 75), who experienced 250 NMOSD-related relapses and received 248 treatments. At 6 months, complete recovery was achieved in 70/98 (71.4%) and 15/19 (79%) patients, respectively. Predictors of a “good” response in our regression model were a younger age at disease onset (OR:3.54, CI95% 2.45–5.01, p < 0.0001) and a short delay from onset of relapse to treatment initiation (OR:1.56, CI95% 1.22–2.13, p = 0.004).

Conclusion

Approximately two-thirds of patients experienced complete recovery, and younger age and a short delay to start treatment were independent predictors of a “good” response.