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A single disease relapse in neuromyelitis optica spectrum disorder is associated with a worsening of disability and health-related quality of life outcomes; therefore, implementing relapse prevention measures is crucial to improving long-term outcomes.

Multiple relapses in patients suffering from neuromyelitis optica spectrum disorder (NMOSD) render them susceptible to long-term disability and poor health-related quality of life (HRQoL). Patients positive for anti-aquaporin 4 antibodies (AQP4+) exhibit damage to the optic nerve (optic neuritis) and the spinal cord (myelitis) during multiple relapses. 

This study evaluated the disability and HRQoL outcomes in patients with AQP4+ NMOSD. The study concluded that a single disease relapse contributed to the worsening of HRQoL and disability; hence, relapse prevention is integral to the improvement in long-term outcomes among AQP4+ NMOSD patients. The study’s findings are published in the journal Frontiers in Neurology.

Baseline Characteristics of Study Participants

The study included a total of 27 patients who were reported to be experiencing independently adjudicated relapse. Twenty relapses were observed in patients administered a placebo. The majority of the on-study relapses were categorized as myelitis, and 26 patients were administered acute treatments. Only one patient was lost to follow-up for all the study outcomes except for the Hauser Ambulation Index (HAI) and the Expanded Disability Status Scale (EDSS).

Worsening in Disability and QoL Scores Following Relapse

Following the relapse, a worsening in the mean disability scores was recorded (p = 0.035). Similarly, there was a significant worsening in the mean HRQoL scores (p < 0.05). The mean scores measured by the European Quality of Life 5-Dimension Questionnaire 3-Level (EQ-5D-3L) were worse at all post-relapse time points (p < 0.05). This study indicated that 25–50% of patients reporting relapse demonstrated clinically meaningful HRQoL and disability outcomes following a single relapse. The proportion of these patients decreased by 11% between 90 and 120 days post-relapse, indicating the stabilization of symptoms of NMOSD relapse. Compared to non-relapsing patients, there was an increased likelihood of clinically meaningful worsening among relapsing NMOSD patients.

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Changes in Visual Acuity Following Single NMOSD Relapse

Based on independent adjudication, 19 out of 27 patients reported having myelitis. The mean pre-relapse visual acuity value was 2.4, with no considerable changes in the visual acuity at post-relapse time points. Therefore, visual acuity does not negatively affect HRQoL or disability outcomes in NMOSD patients who reported myelitis.

Association of Multiple NMOSD Relapses With HRQoL and Disability Outcomes

According to the study findings, NMOSD patients with two relapses were at a greater risk of experiencing clinically meaningful worsening in HRQoL and disability outcomes compared to patients without any relapses.

The study findings indicated that a single disease relapse contributed to the worsening of HRQoL and disability, hence, relapse prevention is integral to the improvement in long-term outcomes among AQP4+ NMOSD patients.

Source

Berthele, A., Levy, M., Wingerchuk, D. M., Pittock, S. J., Shang, S., Kielhorn, A., Royston, M., Sabatella, G., & Palace, J. (2023). A single relapse induces worsening of disability and health-related quality of life in patients with neuromyelitis optica spectrum disorder. Frontiers in Neurology, 14. https://doi.org/10.3389/fneur.2023.1099376