Efficacy and Safety of Immunosuppressants in Elderly Patients with Neuromyelitis Optica Spectrum Disorder

초록

Introduction: Neuromyelitis optica spectrum disorder (NMOSD) is a chronic inflammatory CNS disease that often requires long-term immunosuppressive therapy. While immunosuppressants reduce the risk of relapse, prolonged use may increase adverse events, particularly in older patients. Objectives/Aims: To evaluate the efficacy and safety of long-term immunosuppressive therapy in elderly patients with NMOSD. Methods: We conducted a target trial emulation using the Korean National Health Insurance Service database (2011–2022). Patients diagnosed with NMOSD were categorized based on immunosuppressive therapy and matched 1:2 using propensity scores. Cox proportional hazards models were used to evaluate efficacy outcomes, including the incidence of relapse, and safety outcomes, including infections, fracture, cancer, myocardial infarction, stroke, depression, anxiety, dementia, and Parkinson disease. Results: Among 1,020 patients receiving immunosuppressive therapy and 1,965 controls, the risk of relapse was lower in treated patients (HR = 0.50, 95% CI: 0.28–1.19), particularly in those aged under 60 years (HR = 0.47, 95% CI: 0.20–1.07). However, immunosuppressive therapy was not effective in patients aged over 60 years (HR = 1.49, 95% CI: 0.30–7.50). Severe infections were more common in the treated group (HR = 1.86, 95% CI: 1.07–3.23), especially in patients over 60 years old (HR = 5.80, 95% CI: 2.05–16.4). Conclusion: Immunosuppressive therapy was not effective in preventing relapse in elderly patients with NMOSD and was linked to a higher risk of serious infections. Discontinuation of immunosuppressive therapy may be considered in elderly patients, particularly those at high risk for infections.