Author Of 2 Presentations
P0743 - Patients with neuromyelitis optica spectrum disorder who experience relapses take more chronic pain medication (ID 789)
Patients with neuromyelitis optica spectrum disorder (NMOSD) can experience repeated relapses and increased neurologic disability, such as pain. However, little is known about the impact of relapses on pain and subsequent pain medication use in patients with NMOSD.
A retrospective, observational, cohort analysis was conducted to examine pain medication use in patients with NMOSD.
Patients with anti-aquaporin-4 immunoglobulin G-positive (AQP4+) NMOSD in the University of Utah Health Care System were identified. Electronic data, including patient-level treatments/therapies, medications, health status, and physician notes, were extracted from the Enterprise Data Warehouse and confirmed via chart review by Neurology and Pharmacotherapy faculty members.
Forty-seven patients with AQP4+ NMOSD were included in the analysis. The average age at diagnosis was 46 years; 75% were female, and 70% were white. At the initial presentation of disease, 25 (53%) patients had optic neuritis, 15 (32%) had transverse myelitis, and 7 (15%) had a mixed or unknown presentation. The mean follow-up time was 4 years (standard deviation 3.64 years). During the follow-up period, 14 of 47 patients experienced 26 provider-documented relapses.
Overall, pain medication was used by 45 (95.7%) of 47 patients with AQP4+ NMOSD. A higher proportion of relapsing patients used pain medication than nonrelapsing patients: opioid analgesics (79% vs 58%), non-narcotic analgesics (93% vs 43%), anticonvulsants (86% vs 46%), and musculoskeletal therapy agents (71% vs 46%). Furthermore, among the relapsing patients with AQP4+ NMOSD, pain medication use increased within 90 days of the relapse when compared with the prerelapse use of pain medications: opioids analgesics (27% vs 12%), non-narcotic analgesics (39% vs 12%), anticonvulsants (35% vs 27%), and musculoskeletal therapy agents (39% vs 23%).
In this study, more patients with AQP4+ NMOSD who experienced relapses used pain medication than nonrelapsing patients. In addition, the increase in pain medication use within 90 days following a relapse suggests that pain is associated with relapse activity in patients with NMOSD. Treatment strategies that reduce relapses should be considered for all patients with NMOSD, not only to reduce traditional measures of neurological disability, but also to reduce the burden of pain and accompanying use of relapse-related pain medication.
P0748 - Relapse-associated visual impairment and disability in patients with neuromyelitis optica spectrum disorder (ID 795)
Neuromyelitis optica spectrum disorder (NMOSD) is a relapsing disease predominately affecting the optic nerves and spinal cord. Patients with NMOSD may experience visual and neurological deficits that can lead to blindness and paralysis. However, little is reported about the cumulative impact of relapses on visual acuity and recovery.
A retrospective, observational cohort analysis was conducted to assess the impact of relapses on visual acuity and neurological disability in patients with anti-aquaporin-4 immunoglobulin G-positive (AQP4+) NMOSD.
Patients with AQP4+ NMOSD in the University of Utah healthcare system were identified. Electronic data (health status, physician notes, AQP4+ status, NMOSD diagnosis, and other key patient data) were extracted from the Enterprise Data Warehouse and confirmed via medical chart reviews.
The analysis included 47 patients with AQP4+ NMOSD (mean age at diagnosis: 46 years; female: 75%, white: 70%; median [minimum, maximum] follow-up time: 3.6 [0.0, 11.4] years). At enrollment, 25 patients (53%) had optic neuritis, 15 (32%) had transverse myelitis, and 7 (15%) had a mixed or unknown presentation. Of the 47 patients, 14 experienced a total of 26 relapses, and 33 did not relapse.
Baseline visual acuity was assessed in a subset of symptomatic patients. Data were available for 9 relapsing and 23 nonrelapsing patients. At baseline, 28% of patients had bad eyesight (20/150-no light perception). From baseline to last follow-up, the proportion of patients with bad eyesight increased from 21% to 29% in relapsing patients and decreased from 30% to 24% in nonrelapsing patients.
Neurological disability was assessed via the modified Rankin Scale (mRS). Pre-enrollment mean (standard deviation [SD]) mRS values were similar in relapsing (1.50 [1.22]) and nonrelapsing patients (1.42 [1.39]). At the last visit, the mean (SD) mRS value in relapsing patients was 3.43 (1.79), which was 1.49-fold higher than the mean mRS value in nonrelapsing patients.
In this cohort of patients with AQP4+ NMOSD, the proportion of relapsing patients with bad eyesight increased over time, but the proportion of nonrelapsing patients with bad eyesight decreased. Per the mRS, relapsing patients also experienced increased neurological disability when compared with nonrelapsing patients. Treatment strategies that reduce the risk of relapse should be considered to prevent progression of these deficits in patients with NMOSD.