Login Register Cart 0
Generic placeholder image

Current Neuropharmacology

Editor-in-Chief

ISSN (Print): 1570-159X
ISSN (Online): 1875-6190

Back
Journal Home About Journal Editorial Board Journal Insight Current Issue Volumes/Issues
Subscribe
Systematic Review Article

Effectiveness and Safety of Immunosuppressive Drug Therapy for Neuromyelitis Optica Spectrum Disorders: An Overview of Meta-Analyses and Systematic Reviews

Author(s): Yuan Luo, Yuqian Deng, Haiye Ran, Lei Yu, Caili Ma, Liping Zhao* and Yunchen Li*

Volume 21, Issue 8, 2023

Published on: 16 November, 2022

Page: [1827 - 1834] Pages: 8

DOI: 10.2174/1570159X20666220922151442

Price: $65

conference banner
Abstract

Objective: This study aims to provide an overview of meta-analyses and systematic reviews on the effectiveness and safety of immunosuppressive drug therapy for neuromyelitis optica spectrum disorders (NMOSD) by evaluating the methodological quality and reporting quality of reviews.

Methods: The Chinese National Knowledge Infrastructure (CNKI), WanFang Data, China Science and Technology Journal Database, Web of Science, the Cochrane Library, PubMed, and Embase databases were searched to collect systematic reviews or meta-analyses on the effectiveness and safety of immunosuppressive therapy for NMOSD from inception to December 2, 2021. Two researchers independently screened reviews and extracted data. Any differences in the procession of review assessment between the two researchers were re-evaluated, and the disagreement was resolved by discussion with other researchers. The following data were extracted: author, year of publication, the country where the study was conducted, study type, the number of included studies, sample size, risk bias tools, medication of immunosuppressive therapy, and main outcomes. Then, the AMSTAR-2, which is a critical appraisal tool for systematic reviews (2nd edition), and Grades of Recommendation, Assessment, Development and Evaluation (GRADE) were used to evaluate the methodological quality and reporting quality of evidence. A comprehensive analysis was conducted on the outcomes for all included reviews.

Results: A total of 15 reviews were included. Of the included reviews, 3 were systematic reviews, 7 were meta-analyses, and 5 were systematic reviews and meta-analyses. According to the AMSTAR-2 criteria, 6 studies had high quality, 1 study had moderate quality, 4 studies had low quality, and 4 studies had critically low quality. Based on the GRADE, neither evidence quality for effectiveness nor safety was high.

Conclusion: Immunosuppressive drug therapy is effective for patients with NMOSD, but its safety is controversial. Due to the poor quality of evidence, reliability needs to be considered. Thus, large sample, multi-center, double-blind, randomized controlled studies are still needed in the future.

Keywords: Immunosuppressive Drug Therapy, Neuromyelitis Optica Spectrum Disorders, NMOSD, Drug Effectiveness and Safety, Overview

« Previous
Graphical Abstract

[1]
Wingerchuk, D.M.; Banwell, B.; Bennett, J.L.; Cabre, P.; Carroll, W.; Chitnis, T. International consensus diagnostic criteria for neuromyelitis optica spectrum disorders. Neurology, 2015, 85(2), 177-189.
[http://dx.doi.org/10.1212/WNL.0000000000001729] [PMID: 26092914]
[2]
Kawachi, I.; Lassmann, H. Neurodegeneration in multiple sclerosis and neuromyelitis optica. J. Neurol. Neurosurg. Psychiatry, 2017, 88(2), 137-145.
[http://dx.doi.org/10.1136/jnnp-2016-313300] [PMID: 27671902]
[3]
Pittock, S.J.; Zekeridou, A.; Weinshenker, B.G. Hope for patients with neuromyelitis optica spectrum disorders - from mechanisms to trials. Nat. Rev. Neurol., 2021, 17(12), 759-773.
[http://dx.doi.org/10.1038/s41582-021-00568-8] [PMID: 34711906]
[4]
Wingerchuk, D.M.; Lennon, V.A.; Lucchinetti, C.F.; Pittock, S.J.; Weinshenker, B.G. The spectrum of neuromyelitis optica. Lancet Neurol., 2007, 6(9), 805-815.
[http://dx.doi.org/10.1016/S1474-4422(07)70216-8] [PMID: 17706564]
[5]
Kharel, S.; Shrestha, S.; Ojha, R.; Guragain, N.; Ghimire, R. Safety and efficacy of interleukin-6-receptor inhibitors in the treatment of neuromyelitis optica spectrum disorders: A meta-analysis. BMC Neurol., 2021, 21(1), 458.
[http://dx.doi.org/10.1186/s12883-021-02488-y] [PMID: 34814882]
[6]
Carnero, C.E.; Correale, J. Neuromyelitis optica spectrum disorders: From pathophysiology to therapeutic strategies. J. Neuroinflammation, 2021, 18(1), 208.
[http://dx.doi.org/10.1186/s12974-021-02249-1] [PMID: 34530847]
[7]
Romeo, A.R.; Segal, B.M. Treatment of neuromyelitis optica spectrum disorders. Curr. Opin. Rheumatol., 2019, 31(3), 250-255.
[http://dx.doi.org/10.1097/BOR.0000000000000603] [PMID: 30920972]
[8]
Chan, K.H.; Lee, C.Y. Treatment of neuromyelitis optica spectrum disorders. Int. J. Mol. Sci., 2021, 22(16), 8638.
[http://dx.doi.org/10.3390/ijms22168638]
[9]
Romeo, A.R. Recent advances in the treatment of neuromyelitis optica spectrum disorders. Curr. Opin. Rheumatol., 2021, 33(3), 233-239.
[http://dx.doi.org/10.1097/BOR.0000000000000791] [PMID: 33741809]
[10]
Zhang, C.; Zhang, M.; Qiu, W.; Ma, H.; Zhang, X.; Zhu, Z. Safety and efficacy of tocilizumab versus azathioprine in highly relapsing neuromyelitis optica spectrum disorder (TANGO): An open-label, multicentre, randomised, phase 2 trial. Lancet Neurol., 2020, 19(5), 391-401.
[http://dx.doi.org/10.1016/S1474-4422(20)30070-3] [PMID: 32333897]
[11]
Liberati, A.; Altman, D.G.; Tetzlaff, J.; Mulrow, C.; Gotzsche, P.C.; Ioannidis, J.P. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: Explanation and elaboration. BMJ, 2009, 339, b2700.
[http://dx.doi.org/10.1136/bmj.b2700] [PMID: 32333897]
[12]
Page, M.J.; McKenzie, J.E.; Bossuyt, P.M.; Boutron, I.; Hoffmann, T.C.; Mulrow, C.D. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ, 2021, 2021, 372.
[http://dx.doi.org/10.1136/bmj.n71]
[13]
Singh, J.A.; Christensen, R.; Wells, G.A.; Suarez-Almazor, M.E.; Buchbinder, R.; Lopez-Olivo, M.A. Biologics for rheumatoid arthritis: An overview of Cochrane reviews. Cochrane Database Syst. Rev., 2009, 7(4), CD007848.
[http://dx.doi.org/10.1002/14651858.CD007848] [PMID: 19821440]
[14]
Pussegoda, K.; Turner, L.; Garritty, C.; Mayhew, A.; Skidmore, B.; Stevens, A. Systematic review adherence to methodological or reporting quality. Syst. Rev., 2017, 6(1), 131.
[http://dx.doi.org/10.1186/s13643-017-0527-2] [PMID: 28720117]
[15]
Shea, B.J.; Reeves, B.C.; Wells, G.; Thuku, M.; Hamel, C.; Moran, J. AMSTAR 2: A critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. BMJ, 2017, 358, j4008.
[http://dx.doi.org/10.1136/bmj.j4008] [PMID: 28935701]
[16]
Guyatt, G.; Oxman, A.D.; Akl, E.A.; Kunz, R.; Vist, G.; Brozek, J. GRADE guidelines: 1. Introduction-GRADE evidence profiles and summary of findings tables. J. Clin. Epidemiol., 2011, 64(4), 383-394.
[http://dx.doi.org/10.1016/j.jclinepi.2010.04.026] [PMID: 21195583]
[17]
Damato, V.; Evoli, A.; Iorio, R. Efficacy and safety of rituximab therapy in neuromyelitis optica spectrum disorders: A systematic review and meta-analysis. JAMA Neurol., 2016, 73(11), 1342-1348.
[http://dx.doi.org/10.1001/jamaneurol.2016.1637] [PMID: 27668357]
[18]
Enriquez, C.A.G.; Espiritu, A.I.; Pasco, P.M.D. Efficacy and tolerability of mitoxantrone for neuromyelitis optica spectrum disorder: A systematic review. J. Neuroimmunol., 2019, 332, 126-134.
[http://dx.doi.org/10.1016/j.jneuroim.2019.04.007] [PMID: 31005713]
[19]
Espiritu, A.I.; Pasco, P. Efficacy and tolerability of azathioprine for neuromyelitis optica spectrum disorder: A systematic review and meta-analysis. Mult. Scler. Relat. Disord., 2019, 33, 22-32.
[http://dx.doi.org/10.1016/j.msard.2019.05.011] [PMID: 31136907]
[20]
Giovannelli, J.; Ciron, J.; Cohen, M.; Kim, H.J.; Kim, S.H.; Stellmann, J.P. A meta-analysis comparing first-line immunosuppressants in neuromyelitis optica. Ann. Clin. Transl. Neurol., 2021, 8(10), 2025-2037.
[http://dx.doi.org/10.1002/acn3.51451] [PMID: 34505407]
[21]
Kong, F.; Wang, J.; Zheng, H.; Cai, H.; Hua, J.; Li, L. Monoclonal antibody therapy in neuromyelitis optica spectrum disorders: A meta-analysis of randomized control trials. Front. Pharmacol., 2021, 12, 652759.
[http://dx.doi.org/10.3389/fphar.2021.652759]
[22]
Lotan, I.; McGowan, R.; Levy, M. Anti-IL-6 therapies for neuromyelitis optica spectrum disorders: A systematic review of safety and efficacy. Curr. Neuropharmacol., 2020, 19(2), 220-232.
[http://dx.doi.org/10.2174/1570159X18666200429010825] [PMID: 32348222]
[23]
Luo, D.; Wei, R.; Tian, X.; Chen, C.; Ma, L.; Li, M. Efficacy and safety of azathioprine for neuromyelitis optica spectrum disorders: A meta-analysis of real-world studies. Mult. Scler. Relat. Disord., 2020, 46, 102484.
[http://dx.doi.org/10.1016/j.msard.2020.102484]
[24]
Songwisit, S.; Kosiyakul, P.; Jitprapaikulsan, J.; Prayoonwiwat, N.; Ungprasert, P.; Siritho, S. Efficacy and safety of mycophenolate mofetil therapy in neuromyelitis optica spectrum disorders: A systematic review and meta-analysis. Sci. Rep., 2020, 10(1), 16727.
[http://dx.doi.org/10.1038/s41598-020-73882-8]
[25]
Velasco, M.; Zarco, L.A.; Agudelo-Arrieta, M.; Torres-Camacho, I.; Garcia-Cifuentes, E.; Muñoz, O. Effectiveness of treatments in Neuromyelitis optica to modify the course of disease in adult patients. Systematic review of literature. Mult. Scler. Relat. Disord., 2021, 50, 102869.
[http://dx.doi.org/10.1016/j.msard.2021.102869]
[26]
Wang, Y.; Chang, H.; Zhang, X.; Yin, L. Efficacy of rituximab in the treatment of neuromyelitis optica spectrum disorders: An update systematic review and meta analysis. Mult. Scler. Relat. Disord., 2021, 50, 102843.
[http://dx.doi.org/10.1016/j.msard.2021.102843]
[27]
Xie, Q.; Zheng, T.; Sun, M.; Sun, J.; Wang, M. A meta-analysis to determine the efficacy and safety of tocilizumab in neuromyelitis optica spectrum disorders. Mult. Scler. Relat. Disord., 2020, 45, 102421.
[http://dx.doi.org/10.1016/j.msard.2020.102421]
[28]
Xue, T.; Yu, J.; Chen, S.; Wang, Z.; Yang, Y.; Chen, Z. Different targets of monoclonal antibodies in neuromyelitis optica spectrum disorders: A meta-analysis evidenced from randomized controlled trials. Front. Neurol., 2020, 11, 604445.
[http://dx.doi.org/10.3389/fneur.2020.604445]
[29]
Xue, T.; Yang, Y.; Lu, Q.; Gao, B.; Chen, Z.; Wang, Z. Efficacy and safety of monoclonal antibody therapy in neuromyelitis optica spectrum disorders: Evidence from randomized controlled trials. Mult. Scler. Relat. Disord., 2020, 43, 102166.
[http://dx.doi.org/10.1016/j.msard.2020.102166]
[30]
Wang, Y.; Ma, J.; Chang, H.; Zhang, X.; Yin, L. Efficacy of mycophenolate mofetil in the treatment of neuromyelitis optica spectrum disorders: An update systematic review and meta analysis. Mult. Scler. Relat. Disord., 2021, 55, 103181.
[http://dx.doi.org/10.1016/j.msard.2021.103181]
[31]
Kim, S.H.; Kim, Y.; Kim, G.; Park, N.Y.; Jang, H.M.; Shin, H.J. Less frequent rituximab retreatment maintains remission of neuromyelitis optica spectrum disorder, following long-term rituximab treatment. J. Neurol. Neurosurg. Psychiatry, 2019, 90(4), 486-487.
[http://dx.doi.org/10.1136/jnnp-2018-318465]
[32]
Kim, S.H.; Jeong, I.H.; Hyun, J.W.; Joung, A.; Jo, H.J.; Hwang, S.H.; Yun, S.; Joo, J.; Kim, J.H. Treatment outcomes with rituximab in 100 patients with neuromyelitis optica: Influence of FCGR3A polymorphisms on the therapeutic response to rituximab. JAMA Neurol., 2015, 72(9), 989-995.
[http://dx.doi.org/10.1001/jamaneurol.2015.1276] [PMID: 26167726]

Rights & Permissions Print Cite
© 2024 Bentham Science Publishers | Privacy Policy