Association of immunosuppression treatment with generalization among patients with ocular myasthenia gravis: A propensity score analysis. (7th March 2022)

• Record Type: Journal Article
• Authors: Ruan, Zhe; Guo, Rongjing; Zhou, Hongyu; Gao, Feng; Lin, Ye; Xu, Quan; Yu, Liping; Wu, Songdi; Lei, Tao; Zhang, Min; Gao, Yanwu; Lu, Xiaodan; Li, Huanhuan; Sun, Chao; Tang, Baoli; Li, Zhuyi; Chang, Ting
• Is Part Of: European journal of neurology. Volume 29:Number 6(2022)
• Page Start: 1805
• Page End: 1814
• Publication Date: 2022-03-07
• Subjects: generalization -- generalized myasthenia gravis -- immunosuppression treatment -- ocular myasthenia gravis -- propensity score analysis; Neurology -- Periodicals; Nervous system -- Diseases -- Periodicals; 616.8
• DOI: 10.1111/ene.15292
• Languages: English
• ISSNs: 1351-5101

Abstract

Abstract: Background: To analyze disease generalization in patients with ocular myasthenia gravis (OMG) treated with immunosuppression compared with patients without immunosuppression treatment. Methods: In this retrospective cohort study, we analyzed data from patients with OMG at seven medical centers in China from January 1, 2015 to May 1, 2019 and compared disease generalization in patients (treated with immunosuppression vs. not treated) within 2 years of disease onset using raw and inverse probability of treatment weighting (IPTW) analyses. Results: In the study population of 813 patients with OMG, 425 (52.3%) with immunosuppression had a mean (SD) onset age of 50.0 (15.1) years, and 188 (44.2%) were women. The remaining 388 (47.7%) patients were not immunosuppressed (mean age, 48.4 [15.0] years; 185 [47.7%] women). Disease generalization developed in 122 (31.4%) and 37 (8.7%) patients in the non‐immunosuppression and immunosuppression groups, respectively. Relative to non‐immunosuppression, immunosuppression was associated with a lower risk of generalization in a multivariable‐adjusted Cox model (hazard ratio [HR] 0.27; 95% confidence interval [CI] 0.18–0.40; p < 0.001) and IPTW‐weighted Cox model (HR 0.28; 95% CI 0.19–0.42; p < 0.001). In sensitivity analyses, longer duration of immunosuppression was associated with a lower risk of generalization (HR 0.90 for every 1‐month increase; 95% CI 0.87–0.92; p < 0.001; IPTW‐adjusted). Combination therapy with steroids and non‐steroidal immunosuppressants showed superior efficacy in reducing the risk of generalization (HR 0.14; 95% CI 0.07–0.26; p < 0.001). Conclusion: Immunosuppression significantly reduced the 2‐year risk of generalization in patients with OMG. Abstract : This retrospective study highlighted the important role of immunosuppression treatment in reducing risk of disease generalization in patients with ocular myasthenia gravis. Immunosuppression treatment significantly reduced the risk of generalization. Two‐year cumulative generalization rate was 10.8% in patients with immunosuppression treatment and 32.0% in patients without such treatment, respectively. Combination therapy with steroids and non‐steroidal immunosuppressants showed superior efficacy in reducing the risk of generalization. Two‐year cumulative generalization rate was 20.1% with steroid monotherapy and 5.8% with combination therapy, respectively.