Before immunosuppressive therapy, an increased relapse risk in neuromyelitis optica spectrum disorder was associated with onset age in women, whereas after treatment, predicted relapse risk had a U-shaped correlation with onset age in women in a single-center retrospective review.
Neuromyelitis optica spectrum disorder (NMOSD) is an autoimmune condition that involves damage to the central nervous system mediated by aquaporin-4 (AQP4) antibodies in the majority of cases. NMOSD patients suffer from a relapse-dependent disability, underscoring the importance of relapse prevention.
There is inconsistency in the available evidence regarding the association of relapses with onset age and gender in NMOSD patients. Therefore, this study analyzed relapse patterns before and after immunosuppressive therapy (IST) across different genders and age groups. The study findings are published in the European Journal of Neurology.
Baseline Characteristics
The study included a total of 457 patients with 834 relapses in the analysis of recurrent relapse risk before IST and 452 patients with 753 relapses after IST. The mean onset age of study participants was 41 ± 13 years, and approximately 89% of the study participants were female. Transverse myelitis was the most frequent presentation at first attack in NMOSD, followed by optic neuritis. While optic neuritis was more prevalent in younger participants, the occurrence of transverse myelitis was more frequent in older patients prior to initiation of IST. In the overall cohort, the proportion of transverse myelitis attacks increased following IST.
Correlation Between Onset Age, Relapse Patterns, and Gender Before IST
Compared to patients with a younger onset age, patients with an older onset age had a higher annualized relapse rate overall and for transverse myelitis. Men had significantly greater annualized relapse rates overall in optic neuritis, multifocal relapse, and brain stem/cerebral syndrome. The onset age and predicted relapse risk were found to have a J-shaped association and a U-shaped correlation among women and men, respectively. In early-onset NMOSD, men had a higher relapse risk compared to women.
Correlation Between Onset Age, Relapse Patterns, and Gender After IST
After the initiation of IST, a significant association was found between older age onset and lower recurrent relapse risk in male patients. The predicted relapse risk and onset age were found to have a negative association in male patients and an inverted U-shaped correlation in female patients.
Relapse Patterns and Disability
The increase in severity of the disease was found to be associated with an increase in relapses in the overall study cohort. Both before and after IST initiation, patients with late-onset disease had significantly more rapid disability progression through disease relapses compared to patients with early-onset NMOSD.
Source:
Luo, W., Shi, Z., Kong, L., Wang, X., & Zhou, H. (2023b). Patterns of neuromyelitis optica spectrum disorder attacks in different age groups and sexes depending on the status of immunosuppressive therapy: A retrospective cohort study. European Journal of Neurology. https://doi.org/10.1111/ene.16178
