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Multicenter Study
Effectiveness of mycophenolate mofetil as first-line therapy in AQP4-IgG, MOG-IgG, and seronegative neuromyelitis optica spectrum disorders.
- Alexis Montcuquet, Nicolas Collongues, Caroline Papeix, Helene Zephir, Bertrand Audoin, David Laplaud, Bertrand Bourre, Bruno Brochet, Jean-Philippe Camdessanche, Pierre Labauge, Thibault Moreau, David Brassat, Bruno Stankoff, Jerome de Seze, Sandra Vukusic, Romain Marignier, and NOMADMUS study group and the Observatoire Français de la Sclérose en Plaques (OFSEP).
- 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.
- Mult. Scler. 2017 Sep 1; 23 (10): 1377-1384.
ObjectiveTo evaluate the effectiveness and tolerance of mycophenolate mofetil (MMF) as a first-line treatment in neuromyelitis optica spectrum disorder (NMOSD).MethodsIn 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).ResultsAmong 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.ConclusionMMF 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.
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