1.
Effectiveness and tolerability of different therapies in preventive treatment of MOG-IgG-associated disorder: A network meta-analysis
Wang X, Kong L, Zhao Z, Shi Z, Chen H, Lang Y, Lin X, Du Q, Zhou H
Frontiers in immunology. 2022;13:953993
Abstract
BACKGROUND Immunotherapy has been shown to reduce relapses in patients with myelin oligodendrocyte glycoprotein antibody-associated disorder (MOG-AD); however, the superiority of specific treatments remains unclear. AIM: To identify the efficacy and tolerability of different treatments for MOG-AD. METHODS Systematic search in Pubmed, Embase, Web of Science, and Cochrane Library databases from inception to March 1, 2021, were performed. Published articles including patients with MOG-AD and reporting the efficacy or tolerability of two or more types of treatment in preventing relapses were included. Reported outcomes including incidence of relapse, annualized relapse rate (ARR), and side effects were extracted. Network meta-analysis with a random-effect model within a Bayesian framework was conducted. Between group comparisons were estimated using Odds ratio (OR) or mean difference (MD) with 95% credible intervals (CrI). RESULTS Twelve studies that compared the efficacy of 10 different treatments in preventing MOG-AD relapse, including 735 patients, were analyzed. In terms of incidence of relapse, intravenous immunoglobulins (IVIG), oral corticosteroids (OC), mycophenolate mofetil (MMF), azathioprine (AZA), and rituximab (RTX) were all significantly more effective than no treatment (ORs ranged from 0.075 to 0.34). On the contrary, disease-modifying therapy (DMT) (OR=1.3, 95% CrI: 0.31 to 5.0) and tacrolimus (TAC) (OR=5.9, 95% CrI: 0.19 to 310) would increase the incidence of relapse. Compared with DMT, IVIG significantly reduced the ARR (MD=-0.85, 95% CrI: -1.7 to -0.098). AZA, MMF, OC and RTX showed a trend to decrease ARR, but those results did not reach significant differences. The combined results for relapse rate and adverse events, as well as ARR and adverse events showed that IVIG and OC were the most effective and tolerable therapies. CONCLUSIONS Whilst DMT should be avoided, IVIG and OC may be suited as first-line therapies for patients with MOG-AD. RTX, MMF, and AZA present suitable alternatives.
2.
Significance of changes of T lymphocytes subsets in children with infectious mononucleosis and the effects of different interventions
Chen ZG, Li M, Ji JZ, Chen H, Chen YF, Chen FH
Zhonghua Shi Yan He Lin Chuang Bing Du Xue Za Zhi [Chinese Journal of Experimental and Clinical Virology]. 2009;23((2):):118-20.
Abstract
OBJECTIVE To investigate changes of T lymphocytes subsets in children with infectious mononucleosis (IM) and the effects of different interventions. METHODS Forty-eight children with IM were enrolled, 28 cases were assigned to the group treated with intravenous immunoglobulin (IVIG) 400 mg/(kg x d) for 5 continuous days or IVIG 1 g/(kg x d) for 2 continuous days, the remaining 20 cases were treated with ganciclovir (GCV) 5-10 mg/(kg x d) for 5 consecutive days. All these children were given general supportive therapies. Twenty healthy children from healthcare clinic serviced as control group. RESULTS CD4 (%), CD8 (%) and the CD4/CD8 ratio in healthy control group were (34. 12 +/- 3. 53)%, (26. 22 +/- 4. 43)% and (1. 41 +/- 0. 3), in IVIG group were (24. 2 +/- 4. 3)%, (36. 4 +/- 6. 8)% and (0. 72 +/- 0. 12), and in GCV group were (23. 7 +/- 5. 1)%, (37. 3 +/- 7. 8)% and (0. 67 +/- 0. 13), respectively. CD4 (%), CD8 (%) and the ratio CD4/CD8 in the control group were significantly different from those in both groups with IM (P < 0. 05). Compared with pre-treatment levels, the 28 cases treated with IVIG had significant improvement, the CD4 (%) increased, CD8 (%) decreased and the ratio of CD4/CD8 increased after treatment (P < 0. 05). However, 20 cases in GCV treatment group made less changes (P > 0. 05) . Meanwhile, the clinical symptoms and signs in the IVIG group were improved faster than that in the GCV group (P < 0. 05). The rate of remission in IVIG group was 88. 7% vs. 59. 2% of GCV group (P < 0. 05); the hospital days in IVIG group were (9. 2 +/- 4. 3) days vs. (13. 8 +/- 5. 1) days in the GCV (P < 0. 05). CONCLUSION It is indicated that the subsets of T lymphocytes in peripheral blood are obviously abnormal in children with IM caused by EBV infection in acute phase. IVIG can regulate the immunological derangements of T lymphocytes subsets, on which anti-viral therapy alone may have little impact.