Risk of relapse in patients with neuromyelitis optica spectrum disorder: Recognition and preventive strategy
Risk of relapse in patients with neuromyelitis optica spectrum disorder: Recognition and preventive strategy
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视神经脊髓炎谱系疾病患者复发的风险：识别和预防策略
DOI：
10.1016/j.msard.2020.102522
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发表时间：
2020-11-01
影响因子：
4
通讯作者：
Qiu, Wei
中科院分区：
文献类型：
--
作者：
Ma, Xiaoyu;Kermode, Allan G.;Qiu, Wei
视神经肌萎缩症谱系障碍（NMOSD）是一种罕见的中枢神经系统（CNS）自身免疫性炎症性疾病，其主要与星形胶质细胞中针对水通道蛋白4（AQP4）的血清自身抗体相关。NMOSD的复发性临床过程，由于严重的视力障碍，脊髓病变和一组脑综合征，可能致盲和致残，这表明在疾病的早期阶段准确评估复发的可能性和严重程度的重要性。迄今为止，许多风险因素已被揭示与复发，只有其中一些是由大量的证据支持。此外，虽然常规免疫抑制剂的临床使用大多是经验性的，但越来越多的单克隆抗体新兴疗法已被几项随机安慰剂对照试验证实，对于预防复发是有效和安全的。在这篇综述中，我们总结了可能影响NMOSD复发频率、症状、严重程度和预后的风险因素，以及预防复发的新兴疗法的疗效和安全性。所有这些结果使我们能够更好地识别复发风险较高的患者，并建议在这些患者中使用更有效的单克隆抗体治疗。
Neuromyelitis optica spectrum disorder (NMOSD) is a rare autoimmune inflammatory disorder of the central nervous system (CNS) that is mainly associated with serum autoantibodies against aquaporin-4 (AQP4) in astrocytes. The relapsing clinical course of NMOSD, which can be blinding and disabling due to severe visual impairment, spinal cord lesions and a group of brain syndromes, suggests the importance of accurately evaluating the likelihood and severity of relapse at an early stage of the disease. To date, many risk factors have been revealed in association with relapse, and only some of them are supported by substantial evidence. Furthermore, while the clinical use of conventional immunosuppressants is mostly empirical, an increasing number of emerging therapies for monoclonal antibodies have been confirmed by several randomized placebo-controlled trials to be effective and safe for relapse prevention. In this review, we summarize the reported risk factors that may influence the frequency, symptoms, severity and prognosis of relapse in NMOSD, as well as the efficacy and safety of emerging therapies for relapse prevention. All of these results enable us to better recognize patients who are at higher risk of relapse and suggest more effective monoclonal antibody therapies for use in these patients.