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Background: Neuromyelitis optica spectrum disorders (NMOSD) are a group of antibody-mediated chronic inflammatory diseases of the central nervous system.Rituximab is a monoclonal antibody that leads to a reduction in disease activity.Objective: To evaluate the efficacy of rituximab as monotherapy in NMOSD and to determine whether the efficacy varies depending on the presence of antibodies in this cohort.Method: This multicentre national retrospective study included patients with NMOSD treated with rituximab at least for 12 months from Turkey. The primary outcomes were the change in the annualised relapse rate, the Expanded Disability Status Scale (EDSS), the number of relapse and radiological activity-free patients.Results: A total of 85 patients with NMOSD were included in the study. Of 85 patients, 58 (68.2%) were seropositive for anti-Aquaporin4-IgG (antI-AQP4-IgG). All patients were Anti-Myelin Oligodendrocyte Glycoprotein IgG (anti-MOG-IgG) negative. The median follow-up for rituximab treatment was 21 months (Q1 16-Q3 34.5).During rituximab treatment, the mean annualised relapse rate (ARR) significantly decreased from 1.45 ± 1.53 to 0.15 ± 0.34 (P < .001). In subgroup analyses, the mean ARR decreased from 1.61 ± 1.65 to 0.20 ± 0.39 in the seropositive group and 1.10 ± 1.19 to 0.05 ± 0.13 in the seronegative group. The mean EDSS improved from 3.98 ± 2.04 (prior to treatment onset) to 2.71 ± 1.59 (at follow-up) (P < .001). In the seropositive group, mean EDSS decreased from 3.94 ± 1.98 to 2.67 ± 1.54, and in the seronegative group, mean EDSS decreased from 4.07 ± 2.21 to 2.79 ± 1.73. There was no significant difference between anti-AQP4-IgG (+) and (-) groups in terms of ARR and EDSS. Sixty-four patients (75.2%) were relapse-free after the initiation of treatment. Seventy patients (82.3%) were radiological activity-free in the optic nerve, area postrema and brainstem. Additionally, 78 patients (91.7%) showed no spinal cord involvement after the treatment. Conclusion:Rituximab therapy is efficacious in the treatment of Turkish NMOSD patients independent of the presence of the anti-AQP4-IgG antibody. How to cite this article: Uzunköprü C, Tütüncü M, Gündüz T, et al. The efficacy of rituximab in patients with neuromyelitis optica spectrum disorder: A real-world study from Turkey. Int J

131Secondary brain lymphomas are more common than the primary brain lymphomas, and often present with leptomeningeal lesions. Parenchymal infiltration of the brain is a rare finding. Brain metastases, including secondary brain lymphomas, are occasionally confused with multiple sclerosis (MS) due to their localization and clinical presentation. The patient who is the subject of this manuscript had been followed-up with a diagnosis of MS for a while, until she presented to our clinic with symptoms of cerebellar syndrome. Signs of nephrotic syndrome were identified at this presentation, a year after the onset of symptoms, and the patient was diagnosed as having B-cell non-Hodgkin's lymphoma owing to the results of renal biopsy. The cranial lesions were subsequently interpreted as secondary brain lymphoma and these regressed with chemotherapy (CT). The case was deemed notable for underlining the probability of confusing secondary brain lymphomas with MS and the good response to CT. Keywords:Non-Hodgkin's lymphoma, multiple sclerosis, nephrotic syndrome Sekonder beyin lenfomaları primer beyin lenfomalarından daha sık görülmekte ve genellikle leptomeningeal tutulum ile prezente olmaktadır. Beyin parankim infiltrasyonu nadir olup tutulum yeri ve klinik prezentasyon nedeni ile sekonder beyin lenfoması gibi beyin metastazları nadiren de olsa multipl skleroz (MS) hastalığı ile karışabilmektedir. MS tanısı ile bir süre takip edilen ve şikayetlerinin başlamasından 1 sene sonra serebellar sendrom bulguları ile tarafımıza başvuran ve nefrotik sendrom bulguları tespit edilen hastaya yapılan renal biyopsi sonucu B hücreli non-Hodgkin lenfoma tanısı konuldu ve kranyal lezyonları sekonder beyin lenfoması olarak değerlendirildi. Kemoterapi (KT) sonrası lezyonları geriledi. MS tanısı ile karışabilmesi ve KT'ye iyi yanıtı nedeni ile olgu sunuma değer bulunmuştur.

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