Different doses of Rituximab for the therapy of Neuromyelitis optica spectrum disorder: A systematic review and meta-analysis

Wei, Kenhui; Nie, Qian-Qian; Zhu, Yunfei; Lu, Haifeng; Xue, Qun; Chen, Gang

doi:10.1016/j.msard.2022.104127

Cited by 5 publications

(8 citation statements)

References 33 publications

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“…Several retrospective studies in MS and NMOSD patients demonstrated an indistinguishable efficacy of extended RTX dosing intervals under CD19+ or CD27+ B-cell level monitoring 7 , 25 , 27 , 28 , 40 . A meta-analysis evaluating the efficacy and safety of different doses of RTX in NMOSD showed that an initial dose of 100 mg RTX intravenous infusion per week for three consecutive weeks resulted in the same efficacy as other conventional dose regimens 41 . In the current study, the majority of the patients received a CD19-based reinfusion regimen with a median average dosing interval of 6.8 months (IQR 6.3–7.5) in MS patients and 6.4 months (IQR 6.0–7.8) in NMOSD patients.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of rituximab in multiple sclerosis and neuromyelitis optica spectrum disorder

Ongphichetmetha,

Jitprapaikulsan,

Siritho

et al. 2024

Sci Rep

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In Thailand, resource limitations lead many multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD) patients to use off-label immunosuppressants. This study assesses the efficacy and safety of rituximab (RTX) with a CD19-based reinfusion regimen among Thai MS and NMOSD patients. A retrospective review of patients at the Faculty of Medicine Siriraj Hospital from January 1994 to April 2023 was conducted. The primary outcome assessed was the change in annualized relapse rate (ARR) for patients using RTX for over a year. Secondary outcomes included changes in the Expanded Disability Status Scale (EDSS) scores, time to the first relapse after RTX initiation for patients using RTX for over a year, and an evaluation of the safety of RTX. The study encompassed 36 MS and 39 NMOSD patients. A majority of patients (91.7% of MS and 79.5% of NMOSD) experienced no relapses during a median follow-up of 30 months (Interquartile range [IQR] 20–46) and 31 months (IQR 23–41), respectively. The median ARR significantly decreased in both MS (from 0.77 [IQR 0.42–1.83] to 0 [IQR 0–0], p < 0.001) and NMOSD (from 0.92 [IQR 0.68–1.78] to 0 [IQR 0–0.17], p < 0.001) patients after switching to RTX, with no difference between those following a fixed 6-month time point regimen and a CD19-based reinfusion regimen. Median EDSS scores improved significantly at the last follow-up visit in both groups. The mean time to the first subsequent relapse was 8.3 ± 3.0 months in MS and 6.8 ± 1.7 months in NMOSD. Mild adverse drug reactions occurred in 44% of patients. RTX effectively prevents relapses in Thai MS and NMOSD patients, with no observed serious adverse drug reactions.

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Section: Discussionmentioning

confidence: 99%

Efficacy and safety of rituximab in multiple sclerosis and neuromyelitis optica spectrum disorder

Ongphichetmetha,

Jitprapaikulsan,

Siritho

et al. 2024

Sci Rep

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“… 12 , 19 Patients with NMOSD require lifelong preventive treatment given the potential for devastating relapses and as such, an aim of rituximab therapy should be to administer effective doses, but avoid overtreating which may increase adverse effects, including hypogammaglobulinaemia and infections. 14 …”

Section: Discussionmentioning

confidence: 99%

“…Initial regimens of rituximab for NMOSD were based on the doses used for treating lymphoma – an induction dose of 375 mg/m 2 infused once per week for four weeks or 1000 mg infused twice, two weeks apart, followed by 1000 mg maintenance doses – which were high-cost, off-label therapies, with a higher risk of adverse reactions. 13 , 14 Recent studies assessed the safety and efficacy of different doses of rituximab. 13 , 14 One meta-analysis suggested that a lower dose of rituximab – 100 mg weekly for three weeks – is as effective as higher doses at lowering relapse rate and reducing disability, although RCT data is lacking.…”

Section: Introductionmentioning

confidence: 99%

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Long-term efficacy and safety of rituximab in the treatment of neuromyelitis Optica Spectrum disorder

Hayes,

Adam,

McCombe

et al. 2024

Multiple Sclerosis Journal - Experimental, Translational and Cl

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Background Neuromyelitis optica spectrum disorder (NMOSD) is a relapsing, autoimmune, inflammatory astrocytopathy. Rituximab for B-cell suppression is a common treatment for NMOSD; however, large-scale randomised controlled trials are lacking. Objective Evaluate long-term efficacy and safety of rituximab for NMOSD. Methods Retrospective observational study of patients with NMOSD treated with rituximab. Annualised relapse rates (ARRs) before and during rituximab treatment were evaluated; Modified Rankin Scores (mRS) were measured as a marker of disability. Results In total, 37 patients were included: 27 aquaporin-4-IgG-seropositive and 10 seronegative NMOSD. The predominant rituximab dosing regimen was an initial 1000 mg, split over two 500 mg infusions, two weeks apart, followed by single 500 mg doses. Over a median follow-up of 54 months, ARR for the whole cohort was 0.136 (95% CI 0.088–0.201), significantly lower than the pretreatment ARR of 0.366 (95% CI 0.271–0.483, p < 0.001). There was a significant reduction in ARR for the seropositive subgroup, but not seronegative. Significant improvement in mRS was seen post-treatment. Infections were reported in 32% of patients during follow-up; most were mild. Conclusion Rituximab, at doses lower than traditionally used, may be an efficacious therapy for NMOSD, with a favourable safety profile.

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“…A few different regimens for rituximab induction and strategies for reinfusion exist for NMOSD [ Table 2 ]. [ 30 ] The most commonly used induction regimens are: (1) two infusions of 1 g of rituximab at 2 weeks apart and (2) 375 mg/m 2 of rituximab infusion every week for 4 weeks, both of which would amount to around 2 g in 1 month. [ 11 31 ] For the maintenance phase, reinfusion can be given every 6 months or guided by B-cell monitoring.…”

Section: Onoclonal a Ntibody T ...mentioning

confidence: 99%

Monoclonal antibody therapies for aquaporin-4-immunoglobulin G-positive neuromyelitis optica spectrum disorder and myelin oligodendrocyte glycoprotein antibody-associated disease

Tisavipat,

Juan,

Chen

2023

Saudi Journal of Ophthalmology

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Monoclonal antibody therapies mark the new era of targeted treatment for relapse prevention in aquaporin-4 (AQP4)-immunoglobulin G (IgG)-positive neuromyelitis optica spectrum disorder (AQP4-IgG+NMOSD). For over a decade, rituximab, an anti-CD20 B-cell-depleting agent, had been the most effectiveness treatment for AQP4-IgG+NMOSD. Tocilizumab, an anti-interleukin-6 receptor, was also observed to be effective. In 2019, several randomized, placebo-controlled trials were completed that demonstrated the remarkable efficacy of eculizumab (anti-C5 complement inhibitor), inebilizumab (anti-CD19 B-cell-depleting agent), and satralizumab (anti-interleukin-6 receptor), leading to the Food and Drug Administration (FDA) approval of specific treatments for AQP4-IgG+NMOSD for the first time. Most recently, ravulizumab (anti-C5 complement inhibitor) was also shown to be highly efficacious in an open-label, external-controlled trial. Although only some patients with myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) warrant immunotherapy, there is currently no FDA-approved treatment for relapse prevention in MOGAD. Observational studies showed that tocilizumab was associated with a decrease in relapses, whereas rituximab seemed to have less robust effectiveness in MOGAD compared to AQP4-IgG+NMOSD. Herein, we review the evidence on the efficacy and safety of each monoclonal antibody therapy used in AQP4-IgG+NMOSD and MOGAD, including special considerations in children and women of childbearing potential.

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Different doses of Rituximab for the therapy of Neuromyelitis optica spectrum disorder: A systematic review and meta-analysis

Cited by 5 publications

References 33 publications

Efficacy and safety of rituximab in multiple sclerosis and neuromyelitis optica spectrum disorder

Efficacy and safety of rituximab in multiple sclerosis and neuromyelitis optica spectrum disorder

Long-term efficacy and safety of rituximab in the treatment of neuromyelitis Optica Spectrum disorder

Monoclonal antibody therapies for aquaporin-4-immunoglobulin G-positive neuromyelitis optica spectrum disorder and myelin oligodendrocyte glycoprotein antibody-associated disease

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