PMID- 31425902
OWN - NLM
STAT- MEDLINE
DCOM- 20200403
LR  - 20200403
IS  - 2211-0356 (Electronic)
IS  - 2211-0348 (Linking)
VI  - 35
DP  - 2019 Oct
TI  - Effectiveness and tolerability of immunosuppressants and monoclonal antibodies in 
      preventive treatment of neuromyelitis optica spectrum disorders: A systematic 
      review and network meta-analysis.
PG  - 246-252
LID - S2211-0348(19)30336-0 [pii]
LID - 10.1016/j.msard.2019.08.009 [doi]
AB  - BACKGROUND: Several immunosuppressants or monoclonal antibodies have been used as 
      preventive treatment for neuromyelitis optica spectrum disorders (NMOSD); 
      however, the optimal therapies have not been clarified. In this study, we aimed 
      to compare and rank the effectiveness and tolerability of all preventive 
      therapies for NMOSD. METHODS: Qualified studies were identified in a search of 
      MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), and 
      ClinicalTrials.gov databases. We combined direct and indirect evidence via 
      meta-analyses. The annualized relapse rate (ARR) was defined as the primary 
      outcome. Secondary outcomes included the Expanded Disability Status Scale (EDSS) 
      score and hazard ratios (HR) for the counts of adverse events (AEs). RESULTS: We 
      identified one randomized controlled trial (RCT) and five observational studies 
      including a total 631 patients with NMOSD. Among these, the follow-up time ranged 
      from 12 to 40 months. For the primary outcome, rituximab (RTX) was hierarchically 
      superior, with the significant standardized mean difference versus azathioprine 
      (-0.86; 95% confidence interval: -1.60, -0.11). Mycophenolate mofetil (MMF) was 
      ranked the most tolerable therapy, whereas cyclophosphamide was the least 
      tolerable. CONCLUSION: RTX and MMF may be recommended as optimal treatments to 
      prevent relapse in NMOSD. Low-dose cyclosporine A could be a promising 
      alternative therapy.
CI  - Copyright (c) 2019 Elsevier B.V. All rights reserved.
FAU - Huang, Wenjuan
AU  - Huang W
AD  - Department of Neurology, Huashan Hospital, Fudan University, Shanghai 200040, 
      China.
FAU - Wang, Liang
AU  - Wang L
AD  - Department of Neurology, Huashan Hospital, Fudan University, Shanghai 200040, 
      China.
FAU - Zhang, Baojingzi
AU  - Zhang B
AD  - Department of Neurology, Huashan Hospital, Fudan University, Shanghai 200040, 
      China.
FAU - Zhou, Lei
AU  - Zhou L
AD  - Department of Neurology, Huashan Hospital, Fudan University, Shanghai 200040, 
      China.
FAU - Zhang, Tiansong
AU  - Zhang T
AD  - Department of Chinese Traditional Medicine, Jing'an District Centre Hospital of 
      Shanghai, Fudan University, Shanghai 200040, China. Electronic address: 
      ztsdoctor@126.com.
FAU - Quan, Chao
AU  - Quan C
AD  - Department of Neurology, Huashan Hospital, Fudan University, Shanghai 200040, 
      China. Electronic address: chao_quan@fudan.edu.cn.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Review
PT  - Systematic Review
DEP - 20190809
PL  - Netherlands
TA  - Mult Scler Relat Disord
JT  - Multiple sclerosis and related disorders
JID - 101580247
RN  - 0 (Antibodies, Monoclonal)
RN  - 0 (Immunosuppressive Agents)
SB  - IM
MH  - Antibodies, Monoclonal/*therapeutic use
MH  - Humans
MH  - Immunosuppressive Agents/adverse effects/*therapeutic use
MH  - Network Meta-Analysis
MH  - Neuromyelitis Optica/drug therapy/*prevention & control
MH  - Treatment Outcome
OTO - NOTNLM
OT  - Immunosuppressant
OT  - Immunotherapy
OT  - Monoclonal antibody
OT  - Neuromyelitis optica spectrum disorders
EDAT- 2019/08/20 06:00
MHDA- 2020/04/04 06:00
CRDT- 2019/08/20 06:00
PHST- 2019/07/03 00:00 [received]
PHST- 2019/08/04 00:00 [revised]
PHST- 2019/08/08 00:00 [accepted]
PHST- 2019/08/20 06:00 [pubmed]
PHST- 2020/04/04 06:00 [medline]
PHST- 2019/08/20 06:00 [entrez]
AID - S2211-0348(19)30336-0 [pii]
AID - 10.1016/j.msard.2019.08.009 [doi]
PST - ppublish
SO  - Mult Scler Relat Disord. 2019 Oct;35:246-252. doi: 10.1016/j.msard.2019.08.009. 
      Epub 2019 Aug 9.