
Contributions
Abstract: EP1685
Type: ePoster
Abstract Category: Therapy - disease modifying - 28 Long-term treatment monitoring
Introduction: The therapy of neuromielytis optica spectrum disorders (NMOSD) targets early treatment and prevention of relapses as well as improvement of relapse-associated symptoms. Without adequate relapse prevention most patients will present a devastating stepwise accumulation of disability. Azathioprine was historically used for the management of multiple sclerosis and it is currently widely used in the treatment of NMOSD. An increase in risk of cancer has been reported in patients with long term use of azathioprine for intestinal and rheumatologic diseases. There is no such description for patients with NMOSD. We report our experience with the long term use of azathioprine in NMOSD patients.
Methods: We conducted a retrospective medical record review of all Hospital das Clínicas da Universidade de São Paulo - Brazil- patients who filled NMOSD 2015 criteria and were treated with azathioprine for at least 10 years.
Results: Of 375 reviewed records, 18 patients met inclusion criteria (4.8%); 17 were female and 1 was male, 17 were NMO-IgG seropositive. Median age was 44 years (27-56). Median time of disease was 15 years (10-39). Mean duration of treatment was 12.43 (SD = 3.16). Mean relapse/year rate prior and post introduction of azathioprine was 0.928 (SD = 0.478) and 0.131 (SD = 0.115) with a statistically significant reduction (p < 0.001) on analysis. Eleven of the patients (61.1%) had been free of relapses for at least 5 years. Three patients (16.6%) had records of adverse events during the follow up: chronic B12 deficiency, pulmonary tuberculosis and breast cancer. At the time of the review 13 of the 18 patients (72%) were still receiving azathioprine, 1 had been switched methotrexate due to long exposure to azathioprine, 1 to rituximab due to failure of therapy and the remainder 3 had immunosuppression discontinued due to stability of disease.
Discussion: Adverse events are a concern for patients undergoing long term use of azathioprine; therefore screening is warranted. In our sample, azathioprine was considered relatively safe with only one report of malignancy (5.5 %) and effective in relapse prevention (p < 0.001) at a 10 year follow up.
Conclusion: We believe the risks of adverse events are surpassed by the clinical benefits of azathioprine use, therefore we suggest a vigilant maintenance of therapy for responding patients with long use of the drug.
Disclosure:
Ana Beatriz Ayroza Galvão Ribeiro Gomes: no disclosures.
Aline de Moura Brasil Matos: no disclosures
Laís Maria Gomes de Brito Ventura: no disclosures
Milena Sales Pitombeira: no disclosures
Renata Barbosa Paolilo: no disclosures
Pedro Henrique Bruel Torretta: no disclosures
Frederico Menucci de Haidar Jorge: no disclosures
Douglas Kazutoshi Sato: received research support from Japan Society for the Promotion of Science (JPS KAKENHI 15K19472), CAPES/Brasil (88887.091277/2014-00), Euroimmun AG and TEVA. Speaker for Biogen, Novartis, Genzyme, TEVA, Merk-Serono, Roche, Bayer and advisory board for Shire, Merk-Serono and Quest/Athena Diagnostics.
Dagoberto Callegaro: received grants related to congress meetings and preceptorship from Genzyme, Roche and Biogen.
Samira Luísa Apóstolos Pereira: received grants related to congress meetings and preceptorship from Genzyme and Roche.
Abstract: EP1685
Type: ePoster
Abstract Category: Therapy - disease modifying - 28 Long-term treatment monitoring
Introduction: The therapy of neuromielytis optica spectrum disorders (NMOSD) targets early treatment and prevention of relapses as well as improvement of relapse-associated symptoms. Without adequate relapse prevention most patients will present a devastating stepwise accumulation of disability. Azathioprine was historically used for the management of multiple sclerosis and it is currently widely used in the treatment of NMOSD. An increase in risk of cancer has been reported in patients with long term use of azathioprine for intestinal and rheumatologic diseases. There is no such description for patients with NMOSD. We report our experience with the long term use of azathioprine in NMOSD patients.
Methods: We conducted a retrospective medical record review of all Hospital das Clínicas da Universidade de São Paulo - Brazil- patients who filled NMOSD 2015 criteria and were treated with azathioprine for at least 10 years.
Results: Of 375 reviewed records, 18 patients met inclusion criteria (4.8%); 17 were female and 1 was male, 17 were NMO-IgG seropositive. Median age was 44 years (27-56). Median time of disease was 15 years (10-39). Mean duration of treatment was 12.43 (SD = 3.16). Mean relapse/year rate prior and post introduction of azathioprine was 0.928 (SD = 0.478) and 0.131 (SD = 0.115) with a statistically significant reduction (p < 0.001) on analysis. Eleven of the patients (61.1%) had been free of relapses for at least 5 years. Three patients (16.6%) had records of adverse events during the follow up: chronic B12 deficiency, pulmonary tuberculosis and breast cancer. At the time of the review 13 of the 18 patients (72%) were still receiving azathioprine, 1 had been switched methotrexate due to long exposure to azathioprine, 1 to rituximab due to failure of therapy and the remainder 3 had immunosuppression discontinued due to stability of disease.
Discussion: Adverse events are a concern for patients undergoing long term use of azathioprine; therefore screening is warranted. In our sample, azathioprine was considered relatively safe with only one report of malignancy (5.5 %) and effective in relapse prevention (p < 0.001) at a 10 year follow up.
Conclusion: We believe the risks of adverse events are surpassed by the clinical benefits of azathioprine use, therefore we suggest a vigilant maintenance of therapy for responding patients with long use of the drug.
Disclosure:
Ana Beatriz Ayroza Galvão Ribeiro Gomes: no disclosures.
Aline de Moura Brasil Matos: no disclosures
Laís Maria Gomes de Brito Ventura: no disclosures
Milena Sales Pitombeira: no disclosures
Renata Barbosa Paolilo: no disclosures
Pedro Henrique Bruel Torretta: no disclosures
Frederico Menucci de Haidar Jorge: no disclosures
Douglas Kazutoshi Sato: received research support from Japan Society for the Promotion of Science (JPS KAKENHI 15K19472), CAPES/Brasil (88887.091277/2014-00), Euroimmun AG and TEVA. Speaker for Biogen, Novartis, Genzyme, TEVA, Merk-Serono, Roche, Bayer and advisory board for Shire, Merk-Serono and Quest/Athena Diagnostics.
Dagoberto Callegaro: received grants related to congress meetings and preceptorship from Genzyme, Roche and Biogen.
Samira Luísa Apóstolos Pereira: received grants related to congress meetings and preceptorship from Genzyme and Roche.