ScholarWorks@성균관대학교

초록

Background: Neuromyelitis optica spectrum disorder (NMOSD) can occur in the elderly, but the efficacy and safety of conventional immunosuppressive therapies (ISTs) in this population remain unclear. Methods: We conducted a retrospective target-trial emulation using the Korean National Health Insurance Service database from 2011 to 2022. We constructed 636 weekly emulated trials and included 1020 patients who initiated ISTs and 1965 untreated patients after propensity score matching. The primary outcome was relapse incidence and safety outcomes included serious infection and other adverse events. Age-stratified analyses were prespecified using 60 years as the cutoff. Results: IST recipients had a lower annual relapse incidence than untreated patients, although the adjusted hazard ratio (aHR) did not reach statistical significance (aHR 0.57, 95% CI 0.28–1.19). Age-stratified analyses suggested a numerical relapse reduction in patients aged <60 years, but not in those aged ≥60 years, although statistical significance was not reached. Over the follow-up period, the overall risk of serious infection was similar between groups (aHR 1.11, 95% CI 0.84–1.46). Within the first 6 months after IST initiation, the risk of serious infection was increased, particularly among patients aged ≥60 years (aHR 5.80, 95% CI 2.05–16.40). Conclusions: Evidence was insufficient to determine whether the efficacy of ISTs is reduced in elderly patients with NMOSD. However, IST use was associated with an increased early risk of serious infection, especially among patients aged ≥60 years, suggesting that treatment decisions in older patients require more careful consideration.

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