Meta-Analysis Highlights Clinical Differences Between Patients With NMOSD, MS

A systematic review and meta-analysis examining the characteristics of adult patients with neuromyelitis optica spectrum disorders (NMOSD) and those with multiple sclerosis (MS) found that those with NMOSD were more likely to be older, female, and have worse Expanded Disability Status Scale (EDSS) scores than patients with MS.

Researchers conducted a computerized search on MEDLINE via PubMed, Web of Science, and ProQuest using the relevant keywords to find studies comparing the characteristics between adult patients with NMOSD and those with MS.

“The primary outcome was the characteristics of brain MRI in NMOSD adult patients,” the authors wrote in their study. “These characteristics include demographic characteristics [age and gender], clinical characteristics [EDSS, disease duration, and the number of relapses], clinical symptoms [headache, pyramidal, extrapyramidal, visual, brainstem, and seizures], and lesion characteristics [number, number per patient, location, morphology, diameter, and volume].”

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A total of 23 articles were included in the systematic review and meta-analysis. From those articles, researchers found that patients with NMOSD were associated with older age at presentation (mean difference [MD] = 3.88 [95% CI, 1.80 to 5.97] p = 0.0003) and higher EDSS and (MD = 1.15 [95% CI, 0.58 to 1.72] p < 0.0001) compared with patients with MS. Additionally, the meta-analysis showed that the risk of NMOSD in women was significantly higher than MS (odds ratio [OR] = 2.21 [95% CI, 1.41 to 3.46] p = 0.0005).

Regarding characteristics pertaining to lesions, patients with NMOSD were associated with a lower risk of brainstem involvement symptoms (OR = 0.32 [95% CI, 0.16 to 0.64] p < 0.01), and developing brain lesions compared to patients with MS (OR = 0.08 [95% CI, 0.03 to 0.18] p < 0.00001).

This study had limitations, most notably, significant heterogeneity in some of the analyses. The authors acknowledged that they could not perform subgroup analyses due to lack of data, and the authors noted that there is a need for future research on this topic.

“The current evidence suggests that both NMOSD and MS have different demographic, clinical, and lesion characteristics,” the authors concluded. “There is a need for additional validation of the identified differences compared with MS due to the lack of long-term systematic imaging investigations in NMOSD.”

Reference:
Alqwaifly M, Althobaiti AH, AlAibani NS, et al. Patterns of adult neuromyelitis optica spectrum disorder patients compared to multiple sclerosis: a systematic review and meta-analysis. Cureus. Published online October 24, 2023. doi:10.7759/cureus.47565