Contributions
Abstract: P799
Type: Poster
Abstract Category: Therapy - disease modifying - 32 Others
Introduction: Neuromyelitis optica spectrum disorders (NMOSD) is a recurrent autoimmune inflammatory disease which lead to early disability mainly caused by severity of relapses. The cornerstone of relapse prevention is immunosuppression and the most commonly prescribed include azathioprine, rituximab and mycophenolate mofetil. Adverse events, failure with first-line medications and financial restrictions may prompt the use of methotrexate (MTX), although there are only few reports so far.
Objective: To review our experience using MTX as long-term therapy in NMOSD, evaluating effectiveness and tolerability of MTX in patients with NMOSD aquaporin-4 antibody (AQP4-IgG) seropositive.
Material and methods: We retrospectively assessed data of 167 NMOSD AQP4-IgG positive (CBA method) followed at Hospital das Clínicas, University of São Paulo from 2000-2017. Annualised relapse rate (ARR) 12 months before and on treatment with MTX, Expanded Disability Status Scale (EDSS) and adverse events were evaluated.
Results: 10 met inclusion criteria, 6 were female and median age of onset was 39y (range 22-61). Median treatment duration was 19 months (range 7-120 months), with a median dose of 10 mg/week (range: 10-20 Mg/week). In 8 patients MTX was initiated following adverse events or failure with azathioprine; in 1 it was introduced due to stability of the disease and prolonged use of azathioprine; in 1 it was the first choice. 80% of the patients were relapse-free and 90% had EDSS stability. 1 patients failed with MTX, switching to rituximab. There was no report of MTX interruption due to adverse events.
Conclusion: MTX maintained stability in most patients and was well tolerated in our sample. We believe that MTX is a reasonable choice in patients who had adverse events with azathioprine, considering the context of restricted financial resources.
Disclosure:
Dr Milena Sales Pitombeira: nothing to disclose
Dr Lais M. G. B. Ventura: nothing to disclose
Dr Ana Beatriz A. G. R. Gomes: nothing to disclose
Dr Aline M. B. Matos: nothing to disclose
Dr Renata B. Paolilo: nothing to disclose
Dr Pedro Henrique Bruel Torretta: nothing to disclose
Dr Frederico Mennucci Haidar Jorge: nothing to disclose
Dr Douglas K. Sato receive research support from Japan Society for the promotion of science (JSPS), CAPES/Brasil, Euroimmun AG and TEVA. Speaker for Biogen, Novartis, Genzyme, TEVA, Merck-Serono, Roche, Bayer and advisory board for Shire, Merck-serono and Quest/Athena Diagnostics
Dr Samira Luíza Apóstolos Pereira received grants related to congress meetings and preceptorship from Genzyme and Roche
Dr Dagoberto Callegaro received grants related to congress meetings and preceptorship from Genzyme, Roche and Biogen
Abstract: P799
Type: Poster
Abstract Category: Therapy - disease modifying - 32 Others
Introduction: Neuromyelitis optica spectrum disorders (NMOSD) is a recurrent autoimmune inflammatory disease which lead to early disability mainly caused by severity of relapses. The cornerstone of relapse prevention is immunosuppression and the most commonly prescribed include azathioprine, rituximab and mycophenolate mofetil. Adverse events, failure with first-line medications and financial restrictions may prompt the use of methotrexate (MTX), although there are only few reports so far.
Objective: To review our experience using MTX as long-term therapy in NMOSD, evaluating effectiveness and tolerability of MTX in patients with NMOSD aquaporin-4 antibody (AQP4-IgG) seropositive.
Material and methods: We retrospectively assessed data of 167 NMOSD AQP4-IgG positive (CBA method) followed at Hospital das Clínicas, University of São Paulo from 2000-2017. Annualised relapse rate (ARR) 12 months before and on treatment with MTX, Expanded Disability Status Scale (EDSS) and adverse events were evaluated.
Results: 10 met inclusion criteria, 6 were female and median age of onset was 39y (range 22-61). Median treatment duration was 19 months (range 7-120 months), with a median dose of 10 mg/week (range: 10-20 Mg/week). In 8 patients MTX was initiated following adverse events or failure with azathioprine; in 1 it was introduced due to stability of the disease and prolonged use of azathioprine; in 1 it was the first choice. 80% of the patients were relapse-free and 90% had EDSS stability. 1 patients failed with MTX, switching to rituximab. There was no report of MTX interruption due to adverse events.
Conclusion: MTX maintained stability in most patients and was well tolerated in our sample. We believe that MTX is a reasonable choice in patients who had adverse events with azathioprine, considering the context of restricted financial resources.
Disclosure:
Dr Milena Sales Pitombeira: nothing to disclose
Dr Lais M. G. B. Ventura: nothing to disclose
Dr Ana Beatriz A. G. R. Gomes: nothing to disclose
Dr Aline M. B. Matos: nothing to disclose
Dr Renata B. Paolilo: nothing to disclose
Dr Pedro Henrique Bruel Torretta: nothing to disclose
Dr Frederico Mennucci Haidar Jorge: nothing to disclose
Dr Douglas K. Sato receive research support from Japan Society for the promotion of science (JSPS), CAPES/Brasil, Euroimmun AG and TEVA. Speaker for Biogen, Novartis, Genzyme, TEVA, Merck-Serono, Roche, Bayer and advisory board for Shire, Merck-serono and Quest/Athena Diagnostics
Dr Samira Luíza Apóstolos Pereira received grants related to congress meetings and preceptorship from Genzyme and Roche
Dr Dagoberto Callegaro received grants related to congress meetings and preceptorship from Genzyme, Roche and Biogen