부산대학교 도서관

Aims To compare the efficacy and tolerability of azathioprine (AZA), mycophenolate mofetil (MMF), and cyclophosphamide (CTX) in patients with neuromyelitis optica spectrum disorder (NMOSD). Methods We performed a prospective cohort analysis of relapses, disability, and adverse events in NMOSD patients treated with AZA, MMF, or CTX ( n = 119, 38, and 41, respectively). All the patients were co-treated with oral prednisone. Results A significant reduction in relapse rate was found in patients taking AZA ( p < 0.001), MMF ( p < 0.001) or CTX ( p = 0.01). MMF was associated with a lower risk of relapse than AZA, but this difference was not statistically significant ( p = 0.08). AZA and MMF decreased the mean Expanded Disability Status Scale (EDSS) scores significantly (AZA: p = 0.02; MMF: p = 0.01), whereas CTX did not. Compared with AZA, MMF had a significantly lower risk of treatment discontinuation due to drug-related adverse events ( p = 0.02), whereas CTX had a comparable risk ( p = 0.35). Conclusions MMF is a good first-line treatment option for NMOSD and AZA remains a valuable first-line drug if its side effects are tolerable while CTX can be a treatment option for patients who cannot tolerate AZA and MMF. [ABSTRACT FROM AUTHOR]