The Relapse Prevention Of Neuromyelitis Optica:a Retroapective Therapeutic Study

ObjectiveTo evaluate the efficacy of low-dose predisone (predisone10-20mg/d)、low-dose predisone (10-20mg/d) combined with azathioprine (azathioprine≤100mg/d) and rituximab (rituximab100mg/w) in the prevention of recurrence of neuromyelitis optica (NMO).Methods1. Clinical data in the response to the therapy of70patients with NMO was retrospecively analyzed.2. Regularly followup the patients in the NEUROIMMUNOLOGICAL DISEASE CLINIC. To evaluate Expanded Disability Status Scale (EDSS)score of patients, and assess the patient’s therapy response(mainly glucocorticoid and immunosuppressive agents)3. The annual relapse rate (ARR) and the EDSS were analyzed retrospectively. The data were analyzed between the patients underwent the low dose predisone and those without any treatment during the remmit period; The data collected from the patients who underwent the low dose prednisone combined with azathioprine therapy and those who underwent alone prednisone treatments during the remmit period were compared. To evaluate the impact of rituximab on the relapse and EDSS in NMO.4. Neurologists who qualified the internationalhave passed the examination of the International Institute for the EDSS determine the degree of disability of the patients.Results1. The annual relapse rate during the low-dose steroid treatment was lower than that without treatment(P=0.004).2. The average EDSS score on the last follow up was lower than the baseline EDSS score(P<0.001).3. As predisone tappered to the10mg, relapse rate increased (X2=17.830, P<0.001) 4. Patients who were treated with azathioprine combined with prednisone had a reduction on the total number of relapse (P=0.018) and Expanded Disability Severity Scale score (P=0.006), compared with patients who received alone prednisone treatment.5. Five patients with neuromyelitis optica were treated with rituximab of8months, all of them relapse free. The average scores of EDSS were no significant difference between pre-and post-treatment of rituximab (P=0.374)Conclusion1. The annual relapse rate during the low-dose steroid treatment was lower than that without treatment. It suggests that low-dose steroid treatment is effective on reducing relapse of NMO.2. The average EDSS score on the last follow up was lower than the baseline EDSS score. It suggests that low-dose steroid treatment can reduce EDSS score.3. NMO relapses were most likely to occur when the doses of prednisone was tapered off. When predisone tappered to the10mg/day or less, relapse rate increased, so, oral prednisone10-20mg/d can achieve the lowest effective dose for the prevention of NMO relapse4. Patients who were treated with azathioprine combined with prednisone had a reduction on the total number of relapses and EDSS score, compared with patients who received alone prednisone treatment.5. Five patients with neuromyelitis optica were treated with rituximab for8months, all of them relapse free. The average EDSS score was no significant difference between pre-and post-treatment of rituximab.