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Article Dans Une Revue Annals of Clinical and Translational Neurology Année : 2021

A meta-analysis comparing first-line immunosuppressants in neuromyelitis optica

1 CHU Toulouse - Centre Hospitalier Universitaire de Toulouse
2 URRIS UR2CA - Unité de Recherche Clinique de la Côte d’Azur
3 CHU - Hôpital Pasteur [Nice]
4 Hospital of National Cancer Center [Goyang]
5 CRMBM - Centre de résonance magnétique biologique et médicale
6 TIMONE - Hôpital de la Timone [CHU - APHM]
7 RUB - Ruhr University Bochum = Ruhr-Universität Bochum
8 University of Texas Southwestern Medical Center [Dallas]
9 Hôpital de la Fondation Ophtalmologique Adolphe de Rothschild [AP-HP]
10 CHU Pitié-Salpêtrière [AP-HP]
11 MIRCEM - Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle
12 BMNST - Biopathologie de la Myéline, Neuroprotection et Stratégies Thérapeutiques
13 FMTS - Fédération de Médecine Translationnelle de Strasbourg
14 CHU Rouen
15 CHU Nantes - Centre Hospitalier Universitaire de Nantes
16 U1064 Inserm - CR2TI - Centre de Recherche en Transplantation et Immunologie - Center for Research in Transplantation and Translational Immunology
17 CHU Montpellier
18 INM - Institut des Neurosciences de Montpellier
19 Hôpital neurologique et neurochirurgical Pierre Wertheimer [CHU - HCL]
20 U1215 Inserm - UB - Neurocentre Magendie : Physiopathologie de la Plasticité Neuronale
21 CHU Bordeaux
22 CRNL - Centre de recherche en neurosciences de Lyon - Lyon Neuroscience Research Center
23 CHRU Lille - Centre Hospitalier Régional Universitaire [CHU Lille]
24 RID-AGE - Facteurs de Risque et Déterminants Moléculaires des Maladies liées au Vieillissement - U 1167
25 LilNCog - Lille Neurosciences & Cognition - U 1172
J. Giovannelli
  • Fonction : Auteur
B. Audoin
B. Bourre
  • Fonction : Auteur

Résumé

Objective : As phase III trials have shown interest in innovative but expensive drugs in the treatment of neuromyelitis optica spectrum disorder (NMOSD), data are needed to clarify strategies in the treatment of neuromyelitis optica (NMO). This meta-analysis compares the efficacy of first-line strategies using rituximab (RTX), mycophenolate mofetil (MMF), or azathioprine (AZA), which are still widely used. Methods : Studies identified by the systematic review of Huang et al. (2019) were selected if they considered at least two first-line immunosuppressants among RTX, MMF, and AZA. We updated this review. The Medline, Cochrane Central Register of Controlled Trials, Embase, and ClinicalTrials databases were queried between November 2018 and April 2020. To be included, the hazard ratio (HR) [95% CI] for the time to first relapse after first-line immunosuppression had to be available, calculable, or provided by the authors. Results : We gathered data from 919 NMO patients (232 RTX-, 294 MMF-, and 393 AZA-treated patients). The risk of first relapse after first-line immunosuppression was 1.55 [1.04, 2.31] (p = 0.03) for MMF compared with RTX, 1.42 [0.87, 2.30] (p = 0.16) for AZA compared with RTX, and 0.94 [0.58, 1.54] (p = 0.08) for MMF compared with AZA. Interpretation : The findings suggest that RTX is more efficient than MMF as a first-line therapy. Even if the results of our meta-analysis cannot conclude that RTX has a better efficacy in delaying the first relapse than AZA, the observed effect difference between both treatments combined with the results of previous studies using as outcome the annualized relapse rate may be in favor of RTX.
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Dates et versions

hal-03623634 , version 1 (29-03-2022)

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Paternité - Pas d'utilisation commerciale - Pas de modification

Identifiants

Citer

J. Giovannelli, J. Ciron, M. Cohen, H.-J. Kim, S.-H. Kim, et al.. A meta-analysis comparing first-line immunosuppressants in neuromyelitis optica. Annals of Clinical and Translational Neurology, 2021, 8 (10), pp.2025-2037. ⟨10.1002/acn3.51451⟩. ⟨hal-03623634⟩
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