Efficacy and safety of mycophenolate mofetil therapy in neuromyelitis optica spectrum disorders: a systematic review and meta-analysis

Sakdipat Songwisit,Sasitorn Siritho,Naraporn Prayoonwiwat,Patompong Ungprasert,Jiraporn Jitprapaikulsan,Punchika Kosiyakul

doi:10.1038/s41598-020-73882-8

Abstract

Mycophenolate mofetil (MMF) is an immunosuppressive agent (IS) which is widely prescribed in neuromyelitis optica spectrum disorder (NMOSD) patients. We aim to assess the efficacy and safety of MMF in controlling relapse and disease severity. Eligible studies obtained from the EMBASE and Ovid MEDLINE databases were studies of NMOSD patients treated with MMF, which reported treatment outcomes as Annualized Relapse Rate (ARR) or Expanded Disability Status Scale (EDSS) before and after treatment. Fifteen studies included 1047 patients, of whom 915 (87.4%) were aquaporin-4 immunoglobulin seropositive. The total number of patients that received MMF was 799. A meta-analysis on ARR was conducted in 200 patients from 4 studies and on EDSS in 158 patients from 3 studies. The result showed a significant improvement with a mean reduction of 1.13 [95% confidence interval (CI) 0.60–1.65] in ARR, and a mean reduction of 0.85 (95% CI 0.36–1.34) in EDSS after MMF therapy. Adverse events occurred in 106 (17.8%) of 594 patients during MMF therapy. This systematic review and meta-analysis showed that using MMF as a preventive therapy in NMOSD patients can significantly reduce relapse rates and improve disease severity with acceptable tolerability.

Highlights

Mycophenolate mofetil (MMF) is an immunosuppressive agent (IS) which is widely prescribed in neuromyelitis optica spectrum disorder (NMOSD) patients
There were 1167 articles identified through database searching from
Since disability in NMOSD patients is related to attacks and the accumulation of incomplete recovery, reducing the number of attacks should result in fewer neurological deficits[28]

Summary

Introduction

Mycophenolate mofetil (MMF) is an immunosuppressive agent (IS) which is widely prescribed in neuromyelitis optica spectrum disorder (NMOSD) patients. This systematic review and meta-analysis showed that using MMF as a preventive therapy in NMOSD patients can significantly reduce relapse rates and improve disease severity with acceptable tolerability. Abbreviations NMOSD Neuromyelitis optica spectrum disorders AQP-4 IgG Aquaporin-4 immunoglobulin G ON Optic neuritis TM Transverse myelitis MS Multiple sclerosis AZA Azathioprine MMF Mycophenolate mofetil CYP Cyclophosphamide MPA Mycophenolic acid IMPDH Inosine-5′-monophosphate dehydrogenase ADRs Adverse drug reactions ARR Annualized relapse rate EDSS Expanded Disability Status Scale SD Standard deviation MD Mean difference IS Immunosuppressive agents. Other immunosuppressive agents (IS), including corticosteroids, azathioprine (AZA), mycophenolate mofetil (MMF), methotrexate, cyclophosphamide (CYP), mitoxantrone, and rituximab (RTX) have been used for decades and still remain the standard initial treatment for attack prevention in patients with NMOSD8,9. Treatment with MMF suppresses both cell-mediated immune responses and antibody formation[10]

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