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We aimed to describe the clinical features of patients with NMOSD in different age groups and sexes and to analyse relapse characteristics pre\u2010 and post\u2010immunosuppressive therapy (IST).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Patients with NMOSD were retrospectively reviewed from our clinical centre's database. Demographic and clinical data, attack presentation, and disease course pre\u2010 and post\u2010IST were investigated. We also analysed the effect of onset age on the annualized relapse rate and relapse risk according to sex and IST status. Interactions on the additive scale between onset age and sex were analysed. A restricted cubic spline was used to analyse potential nonlinear correlations. Longitudinal changes in the Expanded Disability Status Scale score across NMOSD attacks were analysed using linear mixed\u2010effect models.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In total, 533 patients experienced 1394 attacks pre\u2010IST and 753 relapses post\u2010IST. Older age at onset was correlated with more myelitis attacks but fewer optic neuritis attacks, with no sex\u2010related differences in attack presentation. Pre\u2010IST, relapse risk increased with age at onset in women, while a U\u2010shaped correlation between onset age and relapse risk was found in men. Post\u2010IST, an inverted U\u2010shaped association between the predicted relapse risk and onset age was observed in women. Conversely, a negative correlation between the predicted relapse risk and onset age was found in men. Overall, a higher ratio of myelitis attacks was found post\u2010IST.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Patients of different onset ages and sexes had different relapse patterns before and after IST.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ene.16178","type":"journal-article","created":{"date-parts":[[2023,12,20]],"date-time":"2023-12-20T16:38:57Z","timestamp":1703090337000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Patterns of neuromyelitis optica spectrum disorder attacks in different age groups and sexes depending on the status of immunosuppressive therapy: A retrospective cohort study"],"prefix":"10.1111","volume":"31","author":[{"given":"Wenqin","family":"Luo","sequence":"first","affiliation":[{"name":"Department of Neurology, West China Hospital Sichuan University  Chengdu P.R. 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