Research Highlights Trends and Impacts of Comorbidities in NMOSD

In order to understand an effect on treatment response and prognosis, recently published findings identified that patients with neuromyelitis optica spectrum disorder (NMOSD) with non-immune comorbidities tend to be older, less responsive to immunotherapy, and are at a higher risk of vision loss and paralysis.

Senior investigator Hongyu Zhou, Department of Neurology, West China Hospital, and colleagues, analyzed patients who met the 2015 criteria for NMOSD with comorbidities (n = 138) and without comorbidities (n = 404). Between the 2 groups, the median age at onset was higher in the comorbidity group by 7 years (45 vs 38; P <.001). This group also showed higher body mass index (BMI) rates (23.12 vs 22.04; P <.042).

"Comorbidities appear to be an important factor influencing disability in patients with NMOSD; therefore, comorbidity screening should be emphasized as part of patient care," Zhou et al wrote. "In addition to immunotherapy, the management of comorbidities is vital, particularly in the intervention of modifiable lifestyle factors."

Both patient groups were more likely to experience a relapse phase; however, the comorbidity group had a slightly greater, non-significant risk (annualized relapse risk [AAR], 0.44) than the non-comorbidity group (ARR, 0.37; P >.05). EDSS scores ended up being higher in the comorbidity group but after adjusting for age at onset, there was no significant difference between the groups (P = .468). Notably, patients on an immunotherapy in the comorbidity group demonstrated a statistically significantly lower risk of relapse (68.5% vs 54.5%; P = .020).

The study investigators noted that medication choice and adherence are influential factors. "Disease-modifying therapy may be contraindicated in the presence of certain comorbidities (e.g., cardiovascular disease and malignancy), and pre-existing comorbidities may also affect the adherence to, durability, tolerability, and possible efficacy of immunotherapy," Zhou et al noted. "Therefore, greater attention should be afforded to the possibility of relapse after receiving treatment, and more intervention studies are needed to confirm whether the treatment of comorbidities affects the relapse rate in patients with NMOSD."

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In comparison, multifocal central nervous system (CNS) lesions as the initial symptom was found in 30.4% of those in the comorbidity group vs 18.32% of those in the non-comorbidity group (P = .003). Severe vision attacks were also more present in the comorbidity group (28.3%) than those without (15.8%; age-adjusted P = .003). While investigators found no significant between-group differences in the frequency of monocular and binocular blindness, monoplegia, hemiplegia, paraplegia, and quadriplegia (P >.05), more patients in the comorbidity group experienced severe motor attacks (30.4% vs 11.9%; P <.001).

In the multivariate model, risk factors for an EDSS score of at least 6 points were diabetes (odds ratio [OR], 2.389; 95% CI, 1.012-5.638; P = .047), older age at onset (OR, 1.057; 95% CI, 1.036-1.078; P <.001), longer disease duration (OR, 1.086; 95% CI, 1.039-1.134; P <.001), and anti-aquaporin-4 Immunoglobulin positivity (OR, 4.302; 95% CI, 1.445-12.803; P = .009). Receiving treatment was a protective factor for an EDSS score of at least 6 points (OR, 0.517; 95% CI, 0.303-0.883; P = .016).

The number of complications did not correlate with the EDSS score or ARR (P >.05), regardless of having only 1 (n = 100), 2 (n = 28), 3 (n = 8), or 4 (n = 2) comorbidities. Hypertension (n = 44), diabetes mellitus (n = 29), and hyperlipidemia (n = 22) were the most common comorbidities in patients with NMOSD. Patients with diabetes only had a higher median ARR than those with both hypertensin and diabetes (0.45 vs 0.1; adjusted P = .038); however, the most recent EDSS score did not significantly differ between those with diabetes and individuals with hypertension.

REFERENCE
1. Cai L, Chen H, Shi Z, et al. Non-immune system comorbidity in neuromyelitis optica spectrum disorders. J Clin Neurosci. 2023;107:16-22. doi:10.1016/j.jocn.2022;11.008.