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Abstract Details

Immunosuppression in Neuromyelitis Optica Spectrum Disorder: A Trial Sequential Analysis and Updated Meta-Analysis
Autoimmune Neurology
P7 - Poster Session 7 (5:00 PM-6:00 PM)
8-015
To compare the safety and efficacy of RTX, AZA, and MMF through an updated meta-analysis and assess the reliability of these findings using trial sequential analysis (TSA).
Neuromyelitis Optica Spectrum Disorder is an autoimmune disease affecting the spinal cord, optic nerves, and brainstem; first-line therapies include Rituximab, Azathioprine, and Mycophenolate Mofetil, but their non-inferiority remains inconclusive. 
MEDLINE, SCOPUS, Web of Science, and Cochrane were systematically for observational studies, as well as single-arm and double-arm randomized controlled trials involving NMOSD patients treated with RTX, AZA, and/or MMF. We used RStudio version 4.3.2 and TSA software for statistics.

37 studies and 2,047 patients were included in the meta-analysis: 1,336 (65.26%) on RTX, 417 (20.37%) on AZA, and 294 (14.36%) on MMF. ARR mean differences improved after treatment with RTX (MD: -1.33, p<0.001), AZA (MD: -0.90, p=0.004), and MMF (MD: -1.12, p<0.001). EDSS improved only with RTX (MD: -0.89, p<0.01). Comparisons of RTX with AZA and MMF showed no significant differences in ARR or EDSS (RTX vs AZA: ARR p=0.05, EDSS p=0.372; RTX vs MMF: ARR p=0.06, EDSS p=0.576). RTX had lower relapse risk (RTX vs. AZA HR: 1.57, p=0.05; RTX vs. MMF HR: 1.93, p<0.001), fewer adverse events (2.83% vs 10.33%, RR: 0.42, p=0.027), lower rates of elevated transaminases (RTX vs AZA: 0% vs 19.7%, p<0.001; RTX vs MMF: 0% vs 17.03%, p=0.015), and less leukopenia (RTX vs AZA: 0% vs 17.46%, p=0.041), but a higher risk of infections (RTX vs MMF: 9.34% vs 2.32%, p=0.033). TSA confirmed findings for ARR and adverse events but was inconclusive for EDSS.

AZA and MMF reduce ARR and EDSS for NMOSD as effectively as RTX but do not reduce the time to relapse. RTX has fewer adverse events but a higher infection risk. Non-specific immunomodulators can be valuable in settings where RTX is unavailable.
Authors/Disclosures
Artur Menegaz de Almeida, MS
PRESENTER 		Mr. Menegaz de Almeida has nothing to disclose.
Juan D. Martinez Lemus, MD (The University of Texas Health Science Center at Houston) Dr. Martinez Lemus has nothing to disclose.
Maria Eduarda Souza Maria Eduarda Souza has nothing to disclose.
Francisco de Moraes Francisco de Moraes has nothing to disclose.
Fernando Luiz Westphal Filho, MS Mr. Westphal Filho has nothing to disclose.
Paulo M. Lopes, Medical student Mr. Lopes has nothing to disclose.
Ítalo B. Andrade Mr. Andrade has nothing to disclose.
Clara Rocha Dantas Miss Rocha Dantas has nothing to disclose.
Mariana R. Reis, Medical Student Miss Reis has nothing to disclose.
Maria I. Reyes, MD (Hospital Simon Bolivar) Dr. Reyes has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Merck. Dr. Reyes has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Biogen. Dr. Reyes has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novartis. Dr. Reyes has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Roche. Dr. Reyes has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis. Dr. Reyes has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Novartis.