PMID- 36884069
OWN - NLM
STAT- MEDLINE
DCOM- 20230518
LR  - 20230519
IS  - 1432-1459 (Electronic)
IS  - 0340-5354 (Print)
IS  - 0340-5354 (Linking)
VI  - 270
IP  - 6
DP  - 2023 Jun
TI  - Different monoclonal antibodies and immunosuppressants administration in patients 
      with neuromyelitis optica spectrum disorder: a Bayesian network meta-analysis.
PG  - 2950-2963
LID - 10.1007/s00415-023-11641-1 [doi]
AB  - BACKGROUND: A variety of novel monoclonal antibodies and immunosuppressant have 
      been proved effective in treating Neuromyelitis Optica Spectrum Disorder (NMOSD). 
      This network meta-analysis compared and ranked the efficacy and tolerability of 
      currently used monoclonal antibodies and immunosuppressive agents in NMOSD. 
      METHODS: Electronic database including PubMed, Embase and Cochrane Library were 
      searched for relevant studies evaluating monoclonal antibodies and 
      immunosuppressants in patients with NMOSD. The primary outcome measures were 
      annualized relapse rate (ARR), relapse rate, the Expanded Disability Status Scale 
      (EDSS) score, and total adverse events (AEs). RESULTS: We identified 25 studies 
      with 2919 patients in our meta-analysis. For the primary outcome, rituximab (RTX) 
      (SUCRA: 0.02) ranked first in reduction ARR with a significant difference 
      compared with azathioprine (AZA) (MD - 0.34, 95% CrI - 0.55 to - 0.12) and 
      mycophenolate mofetil (MMF) (MD -0.38, 95% CrI - 0.63 to - 0.14). Tocilizumab 
      (SUCRA: 0.05) ranked first in relapse rate, which was superior to satralizumab 
      (lnOR - 25.4, 95% CrI - 74.4 to - 2.49) and inebilizumab (lnOR - 24.86, 95% CrI - 
      73.75 to - 1.93). MMF (SUCRA: 0.27) had the fewest AEs followed by RTX (SUCRA: 
      0.35), both of which showed a significant difference compared with AZA and 
      corticosteroids (MMF vs AZA: lnOR - 1.58, 95% CrI - 2.48 to - 0.68; MMF vs 
      corticosteroids: lnOR - 1.34, 95% CrI - 2.3 to - 0.37) (RTX vs AZA: lnOR - 1.34, 
      95% CrI - 0.37 to - 2.3; RTX vs corticosteroids: lnOR - 2.52, 95% CrI - 0.32 to - 
      4.86). In EDSS score, no statistical difference was found between different 
      interventions. CONCLUSION: RTX and tocilizumab showed better efficacy than 
      traditional immunosuppressants in reducing relapse. For safety, MMF and RTX had 
      fewer AEs. However, studies with larger sample size on newly developed monoclonal 
      antibodies are warranted in the future.
CI  - (c) 2023. The Author(s).
FAU - Yin, Ziqian
AU  - Yin Z
AD  - Suzhou Medical College of Soochow University, Suzhou, 215002, Jiangsu Province, 
      China.
FAU - Qiu, Youjia
AU  - Qiu Y
AD  - Department of Neurosurgery and Brain and Nerve Research Laboratory, The First 
      Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006, 
      Jiangsu Province, China.
FAU - Duan, Aojie
AU  - Duan A
AD  - Department of Neurosurgery and Brain and Nerve Research Laboratory, The First 
      Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006, 
      Jiangsu Province, China.
FAU - Fang, Ting
AU  - Fang T
AD  - Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical 
      University), Haikou, 570311, Hainan Province, China.
FAU - Chen, Zhouqing
AU  - Chen Z
AD  - Department of Neurosurgery and Brain and Nerve Research Laboratory, The First 
      Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006, 
      Jiangsu Province, China. zqchen6@163.com.
FAU - Wu, Jiang
AU  - Wu J
AD  - Department of Neurosurgery and Brain and Nerve Research Laboratory, The First 
      Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006, 
      Jiangsu Province, China. szjiangwu@163.com.
FAU - Wang, Zhong
AU  - Wang Z
AD  - Department of Neurosurgery and Brain and Nerve Research Laboratory, The First 
      Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006, 
      Jiangsu Province, China. wangz8761@163.com.
FAU - Chen, Gang
AU  - Chen G
AD  - Department of Neurosurgery and Brain and Nerve Research Laboratory, The First 
      Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006, 
      Jiangsu Province, China.
LA  - eng
GR  - No 82171294/National Natural Science Foundation of China/
PT  - Journal Article
PT  - Meta-Analysis
PT  - Review
DEP - 20230308
PL  - Germany
TA  - J Neurol
JT  - Journal of neurology
JID - 0423161
RN  - 0 (Immunosuppressive Agents)
RN  - 0 (Antibodies, Monoclonal)
RN  - MRK240IY2L (Azathioprine)
RN  - HU9DX48N0T (Mycophenolic Acid)
RN  - 4F4X42SYQ6 (Rituximab)
RN  - 0 (Adrenal Cortex Hormones)
SB  - IM
MH  - Humans
MH  - *Immunosuppressive Agents/therapeutic use
MH  - Antibodies, Monoclonal
MH  - *Neuromyelitis Optica/drug therapy
MH  - Network Meta-Analysis
MH  - Bayes Theorem
MH  - Treatment Outcome
MH  - Azathioprine/therapeutic use
MH  - Mycophenolic Acid/adverse effects
MH  - Rituximab
MH  - Recurrence
MH  - Adrenal Cortex Hormones
PMC - PMC10188410
OTO - NOTNLM
OT  - AZA
OT  - Meta-analysis
OT  - Neuromyelitis optica spectrum disorder
OT  - RTX
OT  - Relapse
COIS- All authors declare that there were no competing interests.
EDAT- 2023/03/09 06:00
MHDA- 2023/05/18 06:42
PMCR- 2023/03/08
CRDT- 2023/03/08 11:13
PHST- 2022/12/08 00:00 [received]
PHST- 2023/02/20 00:00 [accepted]
PHST- 2023/02/19 00:00 [revised]
PHST- 2023/05/18 06:42 [medline]
PHST- 2023/03/09 06:00 [pubmed]
PHST- 2023/03/08 11:13 [entrez]
PHST- 2023/03/08 00:00 [pmc-release]
AID - 10.1007/s00415-023-11641-1 [pii]
AID - 11641 [pii]
AID - 10.1007/s00415-023-11641-1 [doi]
PST - ppublish
SO  - J Neurol. 2023 Jun;270(6):2950-2963. doi: 10.1007/s00415-023-11641-1. Epub 2023 
      Mar 8.