한빛사논문
- 조회386
Ki Hoon Kim1,2, Yeon Hak Chung3,4, Ju-Hong Min3, Hee Jo Han5, Seung Woo Kim5, Ha Young Shin5, Young Nam Kwon5,6, Sung-Min Kim6, Young-Min Lim7, Hyunjin Kim7, Eun-Jae Lee7, Seong Ho Jeong2, Jae-Won Hyun1, Su-Hyun Kim1, Ho Jin Kim1
1Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang, Korea (the Republic of)
2Department of Neurology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea (the Republic of)
3Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)
4Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea (the Republic of)
5Department of Neurology, Yonsei University College of Medicine, Seoul, Korea (the Republic of)
6Department of Neurology, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
7Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (the Republic of)
Correspondence to Dr Su-Hyun Kim
Abstract
Background: The risk-benefit relationship of immunosuppressive therapies (ISTs) for elderly patients with neuromyelitis optica spectrum disorder (NMOSD) is not well established. This study aimed to investigate the safety and efficacy of IST in elderly patients with NMOSD.
Methods: This retrospective study analysed IST efficacy and safety in 101 patients with aquaporin-4 antibody-positive NMOSD aged over 65 years, treated for at least 6 months at five Korean referral centres, focusing on relapse rates, infection events and discontinuation due to adverse outcomes.
Results: The mean age at disease onset was 59.8 years, and female-to-male ratio was 4:1. Concomitant comorbidities at NMOSD diagnosis were found in 87 patients (86%). The median Expanded Disability Status Scale score at the initiation of IST was 3.5. The administered ISTs included azathioprine (n=61, 60%), mycophenolate mofetil (MMF) (n=48, 48%) and rituximab (n=41, 41%). Over a median of 5.8 years of IST, 58% of patients were relapse-free. The median annualised relapse rate decreased from 0.76 to 0 (p<0.001), and 81% experienced improved or stabilised disability. Patients treated with rituximab had a higher relapse-free rate than those treated with azathioprine or MMF (p=0.022). During IST, 21 patients experienced 25 severe infection events (SIEs) over the age of 65 years, and 3 died from pneumonia. 14 patients (14%) experienced 17 adverse events that led to switching or discontinuation of IST. When comparing the incidence rates of SIEs and adverse events, no differences were observed among patients receiving azathioprine, MMF and rituximab.
Conclusion: In elderly patients with NMOSD, IST offers potential benefits in reducing relapse rates alongside a tolerable risk of adverse events.
논문정보
- Research article
- 2024년 05월 (BRIC 등록일 2024-05-24)
- 국내 연구진
- 의약학 > 신경의학
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