Low-Dose Mycophenolate Mofetil for Treatment of Neuromyelitis Optica Spectrum Disorders: A Prospective Multicenter Study in South China

Abstract

Objective: To evaluate the efficacy and safety of low-dose mycophenolate mofetil (MMF, 1,000 mg/day) treatment of neuromyelitis optica spectrum disorders (NMOSDs). Methods: This study was a multicenter, open, prospective, follow-up clinical trial. The data include retrospective clinical data from the pretreatment phase and prospective data from the post-treatment phase. From September 2014 to February 2017, NMOSD patients seropositive for aquaporin 4-IgG (AQP4-IgG) were treated with low-dose MMF. Results: Ninety NMOSD patients were treated with MMF for a median duration of 18 months (range 6-40 months). The median annual recurrence rate (ARR) decreased from 1.02 before treatment to 0 (P < 0.0001) after treatment, and the Expanded Disability Status Scale (EDSS) score decreased from 4 to 3 (P < 0.0001). The EDSS score was significantly lower (P = 0.038) after the first 90 days of treatment. The serum AQP4-IgG titer decreased in 50 cases (63%). The median Simple McGill pain score (SF-MPQ) was reduced in 65 patients (88%) with myelitis from 17 (range 0-35) to 11 (range 0-34) after treatment (P < 0.0001). The median Hauser walking index (Hauser Walk Rating Scale) was reduced from 2 (range 1-9) before treatment to 1 (range 0-7) after treatment (P < 0.0001). Adverse events were documented in 43% of the patients, and eight patients discontinued MMF due to intolerable adverse events. Fourteen (16%) of the total patients discontinued MMF after our last follow-up for various reasons and switched to azathioprine or rituximab. Conclusion: Low-dose MMF reduced clinical relapse and disability in NMOSD patients in South China. However, some patients still suffered from adverse events at this dosage.

Clinical trial registration: www.ClinicalTrials.gov, identifier : NCT02809079.

Keywords: South China; a prospective study; mycophenolate mofetil; neuromyelitis optica spectrum disorders; therapy.

Figures

Figure 1

Flow chart of the inclusion and exclusion processes.

Figure 2

Clinical episodes before and after MMF treatment. For the ARR analysis, we excluded patients with an MMF treatment duration of less than 6 months. The median duration of treatment for the 86 patients was 18 months (range 6–40 months), and the median ARR decreased from 1.02 before treatment to 0 after treatment (P < 0.0001). A total of 90% of the patients had a reduction in the ARR, and 73% of the patients had no clinical recurrence.

Figure 3

Kaplan-Meier survival analysis pertaining to the probabilities of adverse events pre-MMF and post-MMF in 90 patients. All patients were prescribed MMF at time 0. The incidence of adverse events decreased significantly after MMF administration compared to that before MMF treatment (HR = 0.434, 95% CI: 0.202–0.933; P = 0.003).