title: Predictors of response to first-line immunosuppressive therapy in neuromyelitis optica spectrum disorders.
abstract: BACKGROUND
  Azathioprine (AZA) and mycophenolate mofetil (MMF) are the most commonly used first-line therapies for patients with neuromyelitis optica spectrum disorders (NMOSD). However, some patients experience a relapse following AZA or MMF treatment.
  
  
  OBJECTIVE
  To identify factors that predict a response to AZA or MMF in NMOSD.
  
  
  METHODS
  We retrospectively evaluated medical records from 116 patients who were initially treated with AZA or MMF for at least 6 months. Poor response was defined as ⩾2 relapses or ⩾1 severe relapse.
  
  
  RESULTS
  Among the 116 patients, 40 (34%) were classified as poor responders. Logistic regression analyses revealed that a poor response was independently associated with a pre-treatment history of a severe attack ( p < 0.001) and a younger age at disease onset ( p = 0.022). Among the 40 patients with a poor response, 29 (73%) switched to rituximab, and only 3 (10%) had a poor response to rituximab.
  
  
  CONCLUSIONS
  Patients with a pre-treatment history of a severe attack and a younger age of onset exhibited an increased risk of a poor response to AZA or MMF therapy. Identifying patients who are unlikely to respond to AZA or MMF therapy may allow for treatment with more potent therapies that improve treatment outcomes.
authors.affiliation: Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang-si, Korea.
authors.forename: Su-Hyun
authors.initials: SH
authors.lastname: Kim
authors.affiliation: Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang-si, Korea.
authors.forename: Jae-Won
authors.initials: JW
authors.lastname: Hyun
authors.affiliation: Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang-si, Korea.
authors.forename: AeRan
authors.initials: A
authors.lastname: Joung
authors.affiliation: Biometric Research Branch, Research Institute and Hospital of National Cancer Center, Goyang-si, Korea.
authors.forename: Eun Young
authors.initials: EY
authors.lastname: Park
authors.affiliation: Biometric Research Branch, Research Institute and Hospital of National Cancer Center, Goyang-si, Korea.
authors.forename: Jungnam
authors.initials: J
authors.lastname: Joo
authors.affiliation: Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang-si, Korea.
authors.forename: Ho Jin
authors.initials: HJ
authors.lastname: Kim
mesh_terms: D000328:Adult; D017668:Age of Onset; D001379:Azathioprine / Q000008:administration & dosage / Q000494:pharmacology*; D057915:Drug Substitution; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000494:pharmacology*; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000008:administration & dosage / Q000494:pharmacology*; D009471:Neuromyelitis Optica / Q000188:drug therapy*; D017063:Outcome Assessment, Health Care; D012008:Recurrence; D012189:Retrospective Studies; D000069283:Rituximab / Q000008:administration & dosage / Q000494:pharmacology*; D012720:Severity of Illness Index
chemical_list: D007166:Immunosuppressive Agents; D000069283:Rituximab; D009173:Mycophenolic Acid; D001379:Azathioprine
keywords: Neuromyelitis optica; immunosuppressive treatments; neuromyelitis optica spectrum disorder; predictor