Neuromyelitis optica treatment: analysis of 36 patients.

OBJECTIVE To analyze treatment response in Brazilian patients with neuromyelitis optica. DESIGN Retrospective review. SETTING Neuroimmunology Clinic of the Federal University of São Paulo, São Paulo, Brazil. Patients  Thirty-six patients with relapsing-remitting optic-spinal disease; long, extending spinal cord lesions; and brain magnetic resonance images not meeting Barkhof criteria for multiple sclerosis, thus fulfilling the 1999 and 2006 criteria for neuromyelitis optica. Patients were followed up from 1994 to 2007. MAIN OUTCOME MEASURES Relapses and accumulation of disability. RESULTS Mean follow-up time was 47.2 months and mean age at onset was 32.3 years. Sixty-four treatments were implemented in 36 patients, which included interferon beta, methotrexate, cyclophosphamide, prednisone, and azathioprine solely or plus prednisone. Patients who were treated with azathioprine or azathioprine with prednisone had a reduction in the occurrence of relapses and Expanded Disability Severity Scale score stabilization, as opposed to patients who received other treatments. Of the 4 patients who died, only 1 had received azathioprine treatment. CONCLUSION Azathioprine as monotherapy or with prednisone seems to have reduced the relapse frequency and halted disability progression in the majority of patients treated, with minor and manageable adverse effects.