Treatment of Neuromyelitis Optica With Rituximab

Abstract

Background: Neuromyelitis optica (NMO) is an uncommon, life-threatening inflammatory demyelinating disorder. Recently, much has become known about its immunopathogenesis. However, optimal treatments, with expected outcomes, have not been established. Objective: To evaluate the use and efficacy of rituximab for treating NMO. Design: Retrospective multicenter case series of NMO patients treated with rituximab. Setting: Seven tertiary medical centers in the United States and England. Patients: Twenty-five patients (including 2 children), 23 of whom experienced relapses despite use of other drugs before rituximab. Extended follow-up of 7 previously reported patients is included. Interventions: Infusions of rituximab at median intervals of 8 months. Main Outcome Measures: Annualized relapse rate and disability (expressed as Expanded Disability Status Scale score). Results: At a median follow-up of 19 months, the median annualized posttreatment relapse rate was lower than the pretreatment rate (0 [range 0-3.2] vs 1.7 [range, 0.5-5] relapses, PϽ .001). Disability improved or stabilized in 20 of 25 patients (80%, P=.02). Two patients died during the follow-up period, 1 owing to a brainstem relapse and 1 owing to suspected septicemia. Infections were reported in 20% of patients. Conclusions: In NMO, treatment with rituximab appears to reduce the frequency of attacks, with subsequent stabilization or improvement in disability.

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

“…The proportion of AE in this study was lower than that in most conventional-dose studies ( 6 , 8 , 26 , 27 ). In addition, no SAEs leading to discontinuation of treatment were observed in this study.…”

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

“…The proportion of AE in this study was lower than that in most conventional-dose studies ( 6 , 8 , 26 , 27 ). In addition, no SAEs leading to discontinuation of treatment were observed in this study.…”

Neuromyelitis Optica: An Antibody-Mediated Disorder of the Central Nervous System

“…A subsequent retrospective multicenter case series of 25 patients by Jacob et al showed a significant decrease in relapse rate at a median follow-up of 19 months, as well as disability stabilization or improvement in the majority of patients (80%). Of note, 20% of patients in this series developed new or reactivated infections, and 1 patient died of sepsis [83]. In support of the safety profile of this agent, the literature on the use of rituximab in hematological and rheumatological disorders confirms the long-term safety of this agent, with serious adverse effects seen in only a small minority of patients [84].…”

Efficacy and Safety of Rituximab Therapy in Neuromyelitis Optica Spectrum Disorders

“…Forty-six studies were identified and included in the systematic review . The data from the 3 studies by Kim et al were pooled because the authors described the same patient population at different time points.…”

“…Single-case reports and articles without sufficient clinical data were excluded from the quantitative synthesis. Twenty-five studies were included in the meta-analysis.…”

“…The EDSS score was reported in 18 studies included in the meta-analysis (Figure 3). Rituximab treatment resulted in a mean (SE) reduction in the mean EDSS score by 0.64 (0.27) (95% CI, −1.18 to −0.10).…”

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

“…The proportion of AE in this study was lower than that in most conventional-dose studies ( 6 , 8 , 26 , 27 ). In addition, no SAEs leading to discontinuation of treatment were observed in this study.…”

Neuromyelitis Optica: An Antibody-Mediated Disorder of the Central Nervous System

“…A subsequent retrospective multicenter case series of 25 patients by Jacob et al showed a significant decrease in relapse rate at a median follow-up of 19 months, as well as disability stabilization or improvement in the majority of patients (80%). Of note, 20% of patients in this series developed new or reactivated infections, and 1 patient died of sepsis [83]. In support of the safety profile of this agent, the literature on the use of rituximab in hematological and rheumatological disorders confirms the long-term safety of this agent, with serious adverse effects seen in only a small minority of patients [84].…”

Efficacy and Safety of Rituximab Therapy in Neuromyelitis Optica Spectrum Disorders

“…Forty-six studies were identified and included in the systematic review . The data from the 3 studies by Kim et al were pooled because the authors described the same patient population at different time points.…”

“…Single-case reports and articles without sufficient clinical data were excluded from the quantitative synthesis. Twenty-five studies were included in the meta-analysis.…”

“…The EDSS score was reported in 18 studies included in the meta-analysis (Figure 3). Rituximab treatment resulted in a mean (SE) reduction in the mean EDSS score by 0.64 (0.27) (95% CI, −1.18 to −0.10).…”

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

“…The proportion of AE in this study was lower than that in most conventional-dose studies ( 6 , 8 , 26 , 27 ). In addition, no SAEs leading to discontinuation of treatment were observed in this study.…”

Neuromyelitis Optica: An Antibody-Mediated Disorder of the Central Nervous System

“…A subsequent retrospective multicenter case series of 25 patients by Jacob et al showed a significant decrease in relapse rate at a median follow-up of 19 months, as well as disability stabilization or improvement in the majority of patients (80%). Of note, 20% of patients in this series developed new or reactivated infections, and 1 patient died of sepsis [83]. In support of the safety profile of this agent, the literature on the use of rituximab in hematological and rheumatological disorders confirms the long-term safety of this agent, with serious adverse effects seen in only a small minority of patients [84].…”

Efficacy and Safety of Rituximab Therapy in Neuromyelitis Optica Spectrum Disorders

“…Forty-six studies were identified and included in the systematic review . The data from the 3 studies by Kim et al were pooled because the authors described the same patient population at different time points.…”

“…Single-case reports and articles without sufficient clinical data were excluded from the quantitative synthesis. Twenty-five studies were included in the meta-analysis.…”

“…The EDSS score was reported in 18 studies included in the meta-analysis (Figure 3). Rituximab treatment resulted in a mean (SE) reduction in the mean EDSS score by 0.64 (0.27) (95% CI, −1.18 to −0.10).…”