This study provides a longitudinal analysis of NMOSD outcomes using modern treatment methods and finds more promising results than past studies have shown.
Even in patients who undergo immunosuppressive or immunomodulatory therapy, neuromyelitis optica spectrum disorder (NMOSD) tends to follow a progressive disease course with step-wise accumulation of disability over time. The influence of aquaporin-4 (AQP4) seropositivity, AQP4 serum titer levels, and the administration of plasmapheresis on NMOSD prognosis is not currently clear. This study, published in Multiple Sclerosis and Related Disorders, is a retrospective chart review of 53 patients with NMOSD. The data collected includes information about the disease course over time, imaging, demographics, and serum AQP4 titers.
Most patients in the study were treated with high-dose corticosteroids. Following diagnosis, they received immunosuppressive or immunomodulatory therapies as maintenance treatment. The authors used longitudinal data on Kurtzke Expanded Disability Status Scale (EDSS) scores to calculate the slope of disability over time for each patient, and then correlated the initial AQP4 seropositivity, AQP4 serum titer levels, and treatment with plasmapheresis to the overall disability progression. The majority of participants showed either no change or improvement over time. The results also showed no significant association between clinical prognosis and initial AQP4 seropositivity, initial AQP4 serum titer levels, or the administration of plasmapheresis, all of which is contrary to current views on NMOSD.
The authors conclude by noting that this study provides a more favorable view of the clinical course of NMOSD than prior studies, most of which were done prior to high-efficacy disease-modifying therapies becoming widely used. They note that this study cannot provide insight into the disease course of untreated NMOSD, but that it does challenge the idea that AQP4 seropositivity or serum titer levels at the time of diagnosis can predict NMOSD prognosis. Additional research is needed to understand the effects of plasmapheresis administration for overall disease outcomes.
Masha, N., Kimbrough, D. J., Eckstein, C. P., Hudak, N. M., Skeen, M. B., Hartsell, F. L., Lutz, M. W., & Shah, S. (2022). Neuromyelitis optica: Clinical course and potential prognostic indicators. Mult Scler Relat Disord, 69, 104414. https://doi.org/10.1016/j.msard.2022.104414