Rituximab reduces attacks in Chinese patients with neuromyelitis optica spectrum disorders

Ip, Vincent; Lau, Alexander; Au, Lisa; Fan, Florence; Chan, Anna; Mok, Vincent; Wong, Ka Sing

doi:10.1016/j.jns.2012.09.024

Cited by 50 publications

(43 citation statements)

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“…As compared to previous studies our cohort included the higher number of patients and displayed a higher inflammatory activity. It may explain differences with reported disease efficacy (60-100 % of disease-free patients in cohorts with 5-30 NMO patients) [8][9][10]. A retrospective comparison between azathioprine, mycophenolate mofetil (MMF) and rituximab was made by Mealy et al in NMO patients who had similar ARR when first immunosuppression was considered, but some of these patients had received immunomodulating drugs or prednisone treatment before [11].…”

Section: Discussionmentioning

confidence: 99%

“…In spite of a large body of retrospective studies suggesting that immunosuppression may benefit NMO patients, no treatment is currently validated as efficient [1]. Azathioprine is the most widely used therapy worldwide but, in the last decade, some case series have reported the potential interest of mitoxantrone, mofetil mycophenolate, rituximab, and tocilizumab [2][3][4][5][6][7][8][9][10][11][12]. The presence of aquaporin 4 (AQP4) antibodies as a specific pathological marker of the disease led researchers to consider the role of B cells in NMO pathology [13].…”

Section: Introductionmentioning

confidence: 99%

“…The presence of aquaporin 4 (AQP4) antibodies as a specific pathological marker of the disease led researchers to consider the role of B cells in NMO pathology [13]. The potential effect of rituximab, an anti- Service de Neurologie, Hôpital Universitaire de la Timone, Marseille, France CD20 monoclonal antibody, remains discussed [4,5,[7][8][9][10][11] but, fortunately, randomized clinical trials with anti-CD20 and other biologics are ongoing (see clinicaltrial.org, NMO as key word). Although the odds of confirming the interest of anti-CD20 therapy in NMO with those RCT are high, the question of the optimal strategy will not be solved, especially the interest of rituximab use as first-line therapy, and the need for long-term maintenance.…”

Section: Introductionmentioning

confidence: 99%

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Rituximab as first-line therapy in neuromyelitis optica: efficiency and tolerability

et al. 2015

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Neuromyelitis optica (NMO) is a life-threatening disease without any validated treatment strategy. Recent retrospective studies suggested the efficacy of B cell depletion without any distinction between first-line or rescue therapy. To assess whether rituximab as first-line therapy in NMO could efficiently control the occurrence of relapses. A retrospective analysis of NMO patients from NOMADMUS network found 32 patients receiving rituximab as first-line therapy. Main measures were number of relapse-free patients, changes in the annualized relapse rate (ARR), and changes in the EDSS. Tolerance was reported. At baseline, NMO patients were 45 ± 12.1 years old, with a sex ratio of 5.4, and 87.5 % of them had AQP4 antibodies. The median disease duration was 6.5 months (1-410), the mean EDSS was 5.8 ± 2.4 and the mean ARR was 3.8 ± 4.3. After rituximab with a mean follow-up of 28.7 ± 21 months, twenty-seven patients (84.3 %) were relapse free. Patients presented a 97 % decrease of ARR (p = 0.00001). EDSS decreased significantly to 3.9 ± 2.6 (p = 0.01). No relevant side effect was noted. New retrospective data are presented on RTX use in NMOSD. When used as first-line therapy RTX is highly effective and well tolerated.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Rituximab as first-line therapy in neuromyelitis optica: efficiency and tolerability

et al. 2015

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“…Since the use of azathioprine (AZA) with prednisone was first reported in 1998, 3 various immunosuppressants, including mycophenolate mofetil (MMF), 4,5 methotrexate, 6 rituximab, [7][8][9][10][11][12][13][14][15] and mitoxantrone hydrochloride, 16,17 have been introduced as therapeutic options for preventing relapse in patients with NMOSD. Azathioprine is a commonly used immunosuppressant for patients with NMOSD, in which treatment has resulted in a reduction of the annual relapse rate (ARR).…”

mentioning

confidence: 99%

Mycophenolate Mofetil in the Treatment of Neuromyelitis Optica Spectrum Disorder

et al. 2014

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IMPORTANCE Neuromyelitis optica spectrum disorder (NMOSD) is an autoimmune inflammatory disorder of the central nervous system. Recently, various immunosuppressant medications were introduced as therapeutic options for preventing relapse of NMOSD. However, our understanding of the effectiveness of mycophenolate mofetil (MMF) in treating patients with NMOSD is based on only a small number of studies.OBJECTIVE To evaluate the efficacy and safety of MMF treatment in patients with NMOSD. DESIGN, SETTING, AND PARTICIPANTSA 3-center retrospective review of our experiences, examining results from 59 patients with NMOSD (24 with neuromyelitis optica and 35 with a limited form of the disease) who were treated with MMF (1000-2000 mg/d). MAIN OUTCOMES AND MEASURESPatients' annualized relapse rate, disability as measured by the Expanded Disability Status Scale, and experience of adverse effects due to MMF were assessed. RESULTSOf the 59 patients, 1 with NMOSD who had to discontinue MMF use in the first month due to a rash was excluded. The remaining 58 patients were included in the drug-efficacy analysis. The median post-MMF annualized relapse rate was significantly lower than the pre-MMF annualized relapse rate (0.0 vs 1.5; P < .001). The Expanded Disability Status Scale scores also significantly decreased after MMF treatment (3.0 vs 2.5; P = .005). Thirty-five patients (60%) were relapse free, and Expanded Disability Status Scale scores were stabilized or improved in 53 patients (91%). Fourteen patients discontinued MMF treatment owing to ongoing relapse (10 patients), rash (1 patient), pregnancy (1 patient), and financial problems (2 patients), but MMF was generally well tolerated. CONCLUSIONS AND RELEVANCEIn this observational study, MMF treatment induced reduction of relapse frequency, stabilized or improved disability, and was well tolerated in patients with NMOSD.

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“…Open-label studies reported a significant reduction in relapse rate and subsequent stabilization or improvement in disability as measured by expanded disability status scale scores [63,[113][114][115][116][117]. Despite improving relapse rates and reducing disease activity reduced AQP4-IgG titers are not consistently associated with clinical improvement, even after long-term B-cell depletion [118].…”

Section: Inflammatory Myopathiesmentioning

confidence: 99%

Anti-B-Cell Therapies in Autoimmune Neurological Diseases: Rationale and Efficacy Trials

2016

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B cells have an ever-increasing role in the etiopathology of a number of autoimmune neurological disorders, acting as antibody-producing cells and, most importantly, as sensors, coordinators, and regulators of the immune response. B cells, among other functions, regulate the T-cell activation process through their participation in antigen presentation and production of cytokines. The availability of monoclonal antibodies or fusion proteins against B-cell surface molecules or Bcell trophic factors bestows a rational approach for treating autoimmune neurological disorders, even when T cells are the main effector cells. This review summarizes basic aspects of B-cell biology, discusses the role(s) of B cells in neurological autoimmunity, and presents anti-B-cell drugs that are either currently on the market or are expected to be available in the near future for treating neurological autoimmune disorders.

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Rituximab reduces attacks in Chinese patients with neuromyelitis optica spectrum disorders

Cited by 50 publications

References 9 publications

Rituximab as first-line therapy in neuromyelitis optica: efficiency and tolerability

Rituximab as first-line therapy in neuromyelitis optica: efficiency and tolerability

Mycophenolate Mofetil in the Treatment of Neuromyelitis Optica Spectrum Disorder

Anti-B-Cell Therapies in Autoimmune Neurological Diseases: Rationale and Efficacy Trials

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