Efficacy of Low-Dose Rituximab on Neuromyelitis Optica-Associated Optic Neuritis

Zhao, Shilei; Zhou, Huanfen; Xu, Quangang; Dai, Hong; Wei, Shimin

doi:10.3389/fneur.2021.637932

Cited by 4 publications

(9 citation statements)

References 40 publications

(61 reference statements)

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“…RTX reinfusions were administered whenever B cells were repopulated, even though the dosage of RTX varied from one to another (13,18,20,33,34). Greenberg et al (22) compared the time to B-cell repopulation (defined as a CD19 percentage of 2% or greater) after different RTX doses and found that 1000 mg per dose yielded more prolonged B-cell depletion than 100 mg per dose (184 ± 72 days versus 99 ± 36 days), which may provide support to more frequent reinfusion when low RTX dosing strategies were applied (13,27,28,35,36). Although the association of clinical relapses with B-cell repopulation has been well determined to date, it is of note that we have observed that many patients with B-cell repopulation maintained a long-term relapse-free condition in real-world clinical practice.…”

Section: Discussionmentioning

confidence: 99%

Rituximab at lower dose for neuromyelitis optica spectrum disorder: a multicenter, open-label, self-controlled, prospective follow-up study

Zhao

Ren

et al. 2023

Front. Immunol.

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ObjectiveTo address a novel lower-dose rituximab (RTX) therapy strategy based on our clinical experience and assess its efficacy and safety in neuromyelitis optica spectrum disorder (NMOSD).MethodsA multicenter, open-label, self-controlled, prospective follow-up study. Totally, 108 NMOSD patients were enrolled and a lower-dose RTX strategy was applied including 100 mg weekly for 3 weeks and then reinfusions every 6 months. Annualized relapse rate (ARR), the expanded disability status scale (EDSS) score and length of spinal cord lesions were included to evaluate the efficacy. Side effects were recorded to assess the safety profile.ResultsOf 108 patients, 80 (74.1%) initiated low-dose RTX therapy immediately after acute attack treatment and 33 (30.6%) initiated it after the first attack. During a median treatment period of 35.5 (22.0–48.8) months, significant decreases were observed in median ARR (1.1 [0.8–2.0] versus 0 [0–0.2], p < 0.001), EDSS score (3.5 [2.5–4.0] versus 2.0 [1.0–3.0], p < 0.001) and spinal cord lesion segments (5.0 [4.0–8.0] versus 3.0 [1.0–6.0], p < 0.001). The cumulative risk of relapses significantly decreased during the post- versus pre-RTX period (HR 0.238, 95%CI 0.160–0.356, p < 0.001) and on early therapy initiated within 24 months after disease onset versus delayed therapy (HR 0.506, 95%CI 0.258–0.994, p = 0.041). No serious side effects were recorded and all the subjects did not discontinue treatment due to RTX-related side effects.ConclusionOur research provided evidence supporting the lower-dose RTX strategy in treating NMOSD and reopened the issues of optimal dosage and therapy initiation timing.

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Section: Discussionmentioning

confidence: 99%

Rituximab at lower dose for neuromyelitis optica spectrum disorder: a multicenter, open-label, self-controlled, prospective follow-up study

Zhao

Ren

et al. 2023

Front. Immunol.

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“…Some studies took the proportion of CD19 + B lymphocytes in total lymphocyte counts greater than 1% as the indication of reinfusion, and some took worsenings as the indication of reinfusion [16]. Additionally, the percentage of CD19- or CD20-positive B cells of total lymphocytes >1% was regarded as repopulation [13, 14]. CD20 + B cells-guided RTX strategy prolongs the therapy interval and reduces other immunomodulatory drugs usage including immunoglobulin.…”

Section: Discussionmentioning

confidence: 99%

“…In the current study, most studies chose a small dose scheme with the average dose ranged from 100 to 600 mg, and most worsenings correlated with an increase of CD20 + B cells [6,12]. Very low-dose RTX (100 mg) has also been used in other immune-mediated neurological diseases, such as neuromyelitis optica spectrum diseases, either in induction treatment or maintenance treatment [13][14][15]. In the current study, 5 patients were treated with a very low dose of RTX.…”

Section: Discussionmentioning

confidence: 99%

Long-Term Efficacy and Safety of Low-Dose Rituximab in Patients with Refractory Myasthenia Gravis

Ren,

Wang,

Liu

et al. 2023

Eur Neurol

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Introduction: Rituximab is a monoclonal chimeric antibody against CD20+ B cells. We aimed to assess the long-term efficacy and safety of CD20+ B cell-guided treatment with low-dose rituximab in refractory myasthenia gravis patients. Methods: Patients with refractory myasthenia gravis treated with rituximab for more than 2 years were included. Rituximab was administered when CD20+ B cells were greater than 1%. We analysed the efficacy of rituximab, treatment interval, side effects, prognosis, and treatment course. Results: A total of 22 patients were included. All patients received 2–12 doses of rituximab, and the median follow-up time was 48.5 months. The scores of the Myasthenia Gravis Activities of Daily Living and Myasthenia Gravis Composite were significantly lower than those at baseline (p < 0.05). MGFA-PIS was significantly improved in 21 (95.45%) patients and 14 (63.64%) patients have reached MGFA-PIS minimal manifestations. The average daily dose of prednisone and pyridostigmine bromide and the proportion of immunosuppressants were significantly lower (p < 0.05). Seven patients suffered from 14 worsenings. Eight patients terminated rituximab due to good efficacy. Most patients tolerated rituximab well, although 1 patient had opportunistic infection and hypogammaglobulinemia, 1 patient had an intracranial mass. Conclusion: Long-term CD20+ B-cell-guided low-dose rituximab showed good efficacy and tolerance in patients with refractory myasthenia gravis.

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“…Side effects of treatment include possible infusion reaction, opportunistic infections, and delayed leukopenia. Alternatives include low dose rituximab, which is also efficient and well-tolerated in the treatment of NMOSD, with significant decrease in anti-AQP4 antibody concentration after induction treatment and a relapse-free rate of 92.3% in 43 patients followed-up over 12 months 78 . In addition, it is more convenient with a less frequent dosing compared to oral immunosuppressants that need to be taken daily.…”

Section: Discussionmentioning

confidence: 99%

Optic Neuritis in the Era of NMOSD and MOGAD: A Survey of Practice Patterns in Singapore

Foo

Yau

Singhal

et al. 2022

Asia-Pacific Journal of Ophthalmology

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Purpose: The Optic Neuritis Treatment Trial was a landmark study with implications worldwide. In the advent of antibody testing for neuromyelitis optica spectrum disease (NMOSD) and myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD), emerging concepts, such as routine antibody testing and management, remain controversial, resulting mostly from studies in White populations. We evaluate the practice patterns of optic neuritis investigation and management by neuro-ophthalmologists and neurologists in Singapore. Design: 21-question online survey consisting of 4 clinical vignettes. Methods: The survey was sent to all Singapore Medical Council– registered ophthalmologists and neurologists who regularly manage patients with optic neuritis. Results: Forty-two recipients (17 formally trained neuro-ophthalmol-ogists [100% response rate] and 25 neurologists) responded. Participants opted for routine testing of anti–aquaporin-4 antibodies (88.1% in mild optic neuritis and 97.6% in severe optic neuritis). Anti-MOG antibodies were frequently obtained (76.2% in mild and 88.1% in severe optic neuritis). Plasmapheresis was rapidly initiated (85.7%) in cases of nonresponse to intravenous steroids, even before obtaining anti–aquaporin-4 or anti-MOG serology results. In both NMOSD and MOGAD, oral mycophenolate mofetil was the preferred option if chronic immunosuppression was necessary. Steroids were given for a longer duration and tapered more gradually than in idiopathic optic neuritis cases. Conclusions: Serological testing for NMOSD and MOGAD is considered as a routine procedure in cases of optic neuritis in Singapore, possibly due to local epidemiological features of these conditions. Chronic oral immunosuppression is preferred for the long term, but further research is necessary to establish the efficacy and cost-effectiveness of these practices.

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Efficacy of Low-Dose Rituximab on Neuromyelitis Optica-Associated Optic Neuritis

Cited by 4 publications

References 40 publications

Rituximab at lower dose for neuromyelitis optica spectrum disorder: a multicenter, open-label, self-controlled, prospective follow-up study

Rituximab at lower dose for neuromyelitis optica spectrum disorder: a multicenter, open-label, self-controlled, prospective follow-up study

Long-Term Efficacy and Safety of Low-Dose Rituximab in Patients with Refractory Myasthenia Gravis

Optic Neuritis in the Era of NMOSD and MOGAD: A Survey of Practice Patterns in Singapore

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