Comparison Of Efficacy And Safety Of Different Immunosuppressive Agents In Preventing The Recurrence Of Neuromyelitis Optica Spectrum Disorders

Objective:A network meta-analysis was used to compare the effects of seven immunosuppressants on preventing the recurrence,improving disability and the risk of upper respiratory tract infection in neuromyelitis optica spectrum disorders patients(NMOSD).Methods:Three databases including Pub Med,Embase and Cochrane Library were searched.The effect of preventing recurrence was evaluated by RR and and 95%CI of relapse-free rate.The effect of improving disability was evaluated by mean difference MD and95%CI of EDSS change ΔEDSS.The safety of drugs was evaluated by RR and 95%CI of upper respiratory tract infection rate.The efficacy and safety of drugs were ranked by surface under the cumulative ranking curves(SUCRA).Results:12 studies were included,including 7 randomized controlled trials involving 7 drugs,5 monoclonal antibodies and 2 traditional immunodepressant,with a total of 1349 NMOSD patients.In terms of reducing the recurrence rate,eculizumab(86.9%)>satralizumab(69.9%)> tocilizumab(67.3%)> inebilizumab(67.0%)> rituximab(59.2%)> mycophenolate mofetil(21.1%)> azathioprine(21.1%)> placebo(7.3 %).In the case of RCT comparison only,eculizumab(84.2%)> tocilizumab(68.5%)>satralizumab(64.3%)> inebilizumab(60.7%)> rituximab(50.5%)> azathioprine(13.1%)> placebo(8.8%).In terms of improving disability,tocilizumab(65.0%)>rituximab(57.3%)> eculizumab(52.0%)> satralizumab(49.8%)> azathioprine(46.6%)> mycophenolate mofetil(41.9%)> placebo(37.5%).In the case of RCT comparison,tocilizumab(93.9%)> azathioprine(75.7%)> eculizumab(59.2%)>rituximab(28.1%)> satralizumab(25.9%)> placebo(17.1%).In terms of causing upper respiratory tract infection,rituximab(85.3%)> eculizumab(73.4%)> mycophenolate mofetil(53.9%)> satralizumab(43.6%)> inebilizumab(30.9%)> placebo(13.0%).In the case of RCT comparison,rituximab(84.0%)> eculizumab(77.9%)> satralizumab(45.8%)> inebilizumab(30.8%)> placebo(11.6%).Conclusion:In terms of preventing NMOSD recurrences,eculizumab may be the best,in terms of improving disability,tocilizumab may be the best,and in terms of causing upper respiratory tract infection,rituximab may be at the highest risk.