Double-Negative Neuromyelitis Optica Spectrum Disorder: A Systematic Review and Meta-Analysis.

What was studied

This systematic review and meta-analysis looked at double-negative NMOSD. NMOSD is a severe disease usually linked to aquaporin-4 antibodies. Some cases link to MOG antibodies. Double-negative NMOSD is diagnosed without these antibodies. It has been poorly studied. The review aimed to define the clinical range, outlook and treatment response. It compared these with AQP4-NMOSD and MOGAD. The team searched PubMed, Scopus and other sources.

What they found

41 of 1,027 articles were included. They covered 671 people with double-negative NMOSD. Median age was 38.6 years. Median follow-up was 44.4 months. Most people relapsed. The yearly relapse rate was higher in double-negative disease, but not significantly. It was 1.08, versus 0.84 for AQP4-NMOSD and 0.61 for MOGAD. Maintenance immunosuppression led to a significant drop in relapse rate. The pooled rate ratio was 0.19. No covariate, even the drugs used, explained the drop. Disability scores changed significantly in MOGAD only.

What it means for patients

The authors say double-negative NMOSD is a mixed, severe and highly relapsing disease. They say attacks lead to irreversible dysfunction. They say maintenance immunotherapy reduces relapse risk. They point to early use to prevent more disability.

Why it is not certain yet

The abstract reports large differences between studies. The difference in relapse rates between groups was not significant. Disability did not change significantly in AQP4-NMOSD or double-negative disease. The abstract does not say how good the studies were. A review can only be as good as the studies in it.

Source

Double-Negative Neuromyelitis Optica Spectrum Disorder: A Systematic Review and Meta-Analysis.

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