Comorbidities Intensify Rare Neurologic Diseases
METHODOLOGY:
The CROCTINO study was a retrospective, multicentre cohort study that analysed data of 442 patients with AQP4-NMOSD, MOGAD, and double seronegative NMOSD (DN-NMOSD) across 22 centres worldwide between 2000 and 2018, focusing on retinal pathology using optical coherence tomography (OCT).
Researchers assessed comorbidities (classified into 14 categories) and their impact on disease severity, optic neuritis relapse rates, Expanded Disability Status Scale (EDSS) scores, and retinal integrity using OCT.
They compared the prevalence and types of comorbidities across disease groups, evaluated associations with clinical outcomes, and analysed changes in retinal layer thickness.
TAKEAWAY:
Comorbidities were present in 43.5% of patients with AQP4-NMOSD, 40.8% of those with MOGAD, and 36.4% of those with DN-NMOSD. Those with AQP4-NMOSD had more multiple comorbidities than those with MOGAD (50% vs 25%; P = .03).
= .03). EDSS scores were higher in patients with MOGAD and comorbidities than in those without (3.0 vs 2.0; P = .006) and in those with DN-NMOSD and comorbidities than in those without (5.0 vs 2.0; P = .008), but not significantly different between those with AQP4-NMOSD and those without.
= .006) and in those with DN-NMOSD and comorbidities than in those without (5.0 vs 2.0; = .008), but not significantly different between those with AQP4-NMOSD and those without. Among patients with AQP4-NMOSD, those with cardiovascular comorbidities exhibited higher annual optic neuritis relapses than those with autoimmune comorbidities (mean, 1.06 ± 3.33 vs 0.49 ± 0.98; P < .001).
< .001). Retinal changes showed reduced inner nuclear layer thickness in patients with AQP4-NMOSD having comorbidities, especially cardiovascular conditions ( P = .009).
IN PRACTICE:
"Comorbidities are frequent in AQP4-NMOSD and MOGAD and are associated with ON [optic neuritis] frequency and disability. These findings highlight the need for proactive comorbidity management to improve patient care," the authors wrote.
SOURCE:
This study, led by Sara Samadzadeh, Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark, was published online on June 09, 2025, in the European Journal of Neurology .
LIMITATIONS:
This study's retrospective design may have led to inaccuracies in comorbidity documentation, including unrecorded risk factors (eg, smoking) and inconsistent data recorded. Some comorbidities could independently affect OCT or EDSS outcomes, potentially confounding the results.
DISCLOSURES:
This study was supported by the Lundbeck Foundation; the University of Southern Denmark, Slagelse Hospital Research Fund, and Region Zealand Health Sciences Research Fund; and the Guthy-Jackson Charitable Foundation. Some authors reported receiving support from several other organisations.
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