Effects of early using azathioprine in the acute phase in neuromyelitis optica spectrum disorder

Abstract

Background: Azathioprine is widely used for neuromyelitis optica spectrum disorder (NMOSD) patients, while a consensus of timing to receive azathioprine has not been proposed. Objective: The objective of this paper was to evaluate the efficacy of early access of azathioprine in NMOSD patients. Methods: We conducted a retrospective review of NMOSD patients based on medical records. Included patients were divided into three groups: group IVMT + AZA, group AZA after IVMT and group IVMT. Time to next relapse was adopted as the endpoint. Results: Patients from group IVMT + AZA had a longer duration of remission compared with patients from group AZA after IVMT ( p = 0.025) and group IVMT ( p < 0.001), and longer duration showed in the group AZA after IVMT when compared with group IVMT ( p = 0.005). We found that older age of initial attack was a risk factor for NMOSD patients (HR: 1.235; p = 0.022), and younger age of receiving treatment was a protect factor (HR: 0.804; p = 0.023). Partial patients have used azathioprine before this study in group IVMT + AZA, result showed there was no significance between the patients who had or had not used azathioprine ( p = 0.299). Conclusion: Azathioprine could prolong the duration of remission after treatment, especially given within two weeks after attack. Patients who received azathioprine combined with glucocorticoids had a preferable effect than glucocorticoids alone in the remission.