Evidence map›Paper›PMID 41637688›Full record

ArticleNeurology(R) neuroimmunology & neuroinflammation2026

Comparative Effectiveness of Disease-Modifying Treatments in Double Seronegative Neuromyelitis Optica Spectrum Disorder.

Joao Vitor Mahler, Gerome B Vallejos, Takahisa Mikami, Philippe A Bilodeau, Monique Anderson, Natalia Drosu, Natasha Bobrowski-Khoury, Guilherme Diogo Silva, Marina Solti, Samira Luisa Apóstolos-Pereira and 28 more

Erratum issuedAbstract readComparative StudyMulticenter Study
In one paragraph

Article in Neurology(R) neuroimmunology & neuroinflammation, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Article
  2. Review
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

38 authors.

Joao Vitor MahlerDivision of Neuroimmunology & Neuroinfectious Disease, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA.ORCID 0000-0002-0700-3517
Gerome B VallejosDivision of Neuroimmunology & Neuroinfectious Disease, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA.ORCID 0000-0001-6006-3909
Takahisa MikamiDivision of Neuroimmunology & Neuroinfectious Disease, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA.ORCID 0000-0003-1851-5259
Philippe A BilodeauDivision of Neuroimmunology & Neuroinfectious Disease, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA.ORCID 0000-0002-2672-554X
Monique AndersonDivision of Neuroimmunology & Neuroinfectious Disease, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
Natalia DrosuDivision of Neuroimmunology & Neuroinfectious Disease, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
Natasha Bobrowski-KhouryDivision of Neuroimmunology & Neuroinfectious Disease, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
Guilherme Diogo SilvaDepartamento de Neurologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.ORCID 0000-0001-9764-3763
Marina SoltiDepartamento de Neurologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
Samira Luisa Apóstolos-PereiraDepartamento de Neurologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
Dagoberto CallegaroDepartamento de Neurologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.ORCID 0000-0003-0077-173X
Bruna Leles Vieira de SouzaDivision of Neuroimmunology & Neuroinfectious Disease, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA.ORCID 0000-0002-1918-3818
Giovanna Sophia ManzanoDivision of Neuroimmunology & Neuroinfectious Disease, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA.ORCID 0000-0002-9991-9222
Anastasia VishnevetskyDivision of Neuroimmunology & Neuroinfectious Disease, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA.ORCID 0000-0002-0269-7441
Rebecca GillaniDivision of Neuroimmunology & Neuroinfectious Disease, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
Olivia PasqualeCreighton University School of Medicine, Phoenix, AZ.
Angie KimNYU Grossman School of Medicine, New York, NY.
Raveena VijNYU Grossman School of Medicine, New York, NY.
Ilya KisterNYU Grossman School of Medicine, New York, NY.ORCID 0000-0003-3549-949X
Emily L GibbonsWalton Centre NHS Foundation Trust, Liverpool, United Kingdom.ORCID 0000-0002-9723-3331
Anu JacobWalton Centre NHS Foundation Trust, Liverpool, United Kingdom.ORCID 0000-0002-7530-6800
Saif HudaWalton Centre NHS Foundation Trust, Liverpool, United Kingdom.ORCID 0000-0003-0980-3750
Yana SaidDepartment of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD.
Jonathan D KrettDepartment of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD.ORCID 0000-0003-4964-3341
Elias S SotirchosDepartment of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD.ORCID 0000-0002-8812-1637
Manisha RamprasadCase Western Reserve University School of Medicine, Cleveland, OH.
Hesham AbboudCase Western Reserve University School of Medicine, Cleveland, OH.ORCID 0000-0001-5346-8254
Viviane Tavares Carvalho CrelierUniversidade Federal Fluminense, Niteroi, Brazil.ORCID 0000-0003-4081-5012
Gutemberg Dos SantosUniversidade Federal Fluminense, Niteroi, Brazil.
Ekdanai UawithyaSiriraj Neuroimmunology Center, Siriraj Hospital, Mahidol University, Bangkok, Thailand.ORCID 0009-0008-6262-8158
Sasitorn SirithoSiriraj Neuroimmunology Center, Siriraj Hospital, Mahidol University, Bangkok, Thailand.ORCID 0000-0002-2562-697X
Ahmetcan SezenKoc University School of Medicine, Istanbul, Turkiye.
Ayse AltintasKoc University School of Medicine, Istanbul, Turkiye.ORCID 0000-0002-8524-5087
Feng GaiDepartment of Neurology, Beijing Tongren Hospital, Capital Medical University, Beijing, China.ORCID 0009-0004-2947-0660
Yanjun GuoDepartment of Neurology, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
Shamik BhattacharyyaDepartment of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.ORCID 0000-0001-8047-3622
Michael LevyDivision of Neuroimmunology & Neuroinfectious Disease, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA.ORCID 0000-0002-7969-8346
Marcelo MatielloDivision of Neuroimmunology & Neuroinfectious Disease, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA.ORCID 0000-0001-9753-8816

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

BACKGROUND AND

objectivesDouble seronegative NMOSD (DS-NMOSD) lacks approved disease-modifying treatments, and limited data exist on optimal relapse-prevention strategies. In this multicenter, international, retrospective cohort study, we sought to compare the real-world effectiveness of anti-CD20 agents vs nonspecific immunosuppressants as disease-modifying strategies for relapse prevention in DS-NMOSD.

methodsA retrospective cohort database was constructed using standardized data collection from medical records across collaborating centers in the United States, Brazil, the United Kingdom, Thailand, Turkiye, and China. Patients meeting IPND-2015 NMOSD criteria with negative serum aquaporin-4 and myelin oligodendrocyte glycoprotein antibody testing via cell-based assays and at least 12 months of follow-up were reviewed. The primary outcome was the incidence rate ratio (IRR) of relapses; secondary outcomes included the annualized relapse rate (ARR) and time to relapse.

resultsA total of 103 patients with DS-NMOSD met study criteria, with a median follow-up of 6 years. Anti-CD20 therapy was associated with a significantly lower IRR (0.02, 95% CI 0.01-0.04) and ARR (0.17, 95% CI 0.07-0.40) compared with nonspecific immunosuppressants (0.76, 95% CI 0.40-1.43) after adjusting for covariates. Survival analysis demonstrated a prolonged relapse-free interval with anti-CD20 agents. DISCUSSION: Our findings support the use of B-cell depletion as a potentially superior relapse-prevention strategy in DS-NMOSD, highlighting its potential as a first-line therapy. CLASSIFICATION OF EVIDENCE: This study provides Class IV evidence that, in patients with DS-NMOSD, treatment with a DMT reduces relapse incidence rate ratio compared with no treatment and anti-CD20 DMTs are associated with a lower relapse incidence rate ratio compared with nonspecific immunosuppressants.

Indexed as

Immunologic FactorsImmunosuppressive AgentsNeuromyelitis OpticaOutcome Assessment, Health CareRituximabAdultFemaleHumansMaleMiddle AgedRetrospective StudiesSecondary PreventionImmunologic FactorsImmunosuppressive AgentsRituximab

Identifiers

PMID41637688
PMCPMC12879023

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.