The efficacy of rituximab in patients with neuromyelitis optica spectrum disorder: A real‐world study from Turkey

Abstract

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

Rituximab Therapy for Immune-Mediated Neurological Diseases: Our Experience at a Tertiary Care Centre

“…The EDSS scores decreased from 3.94 ± 1.98 to 2.67 ± 1.54, and ARR decreased from 1.45 ± 1.53 to 0.15 ± 0.34. No radiological activity was observed or assessed at intervals of one year, which is similar to our study [19]. Both the RIN-1 study and the meta-analysis conducted by Gao et al showcased promising results of RTX in this patient group [20,21].…”

A meta-analysis on efficacy and safety of rituximab for neuromyelitis optica spectrum disorders

“…Effects on ARR. A total of 26 studies [2,3,5,7,8,[10][11][12]17,[19][20][21][23][24][25][26][27][28][32][33][34][35][36][37][38][39] were reported ARR before and after RTX therapy in patients with NMOSD. The results of Meta-analysis showed that the ARR of NMOSD patients after RTX treatment was significantly decreased by 1.45, and the difference was statistically significant (WMD = 1.45, 95% CI: 1.24-1.66, P < .01).…”

Serum Proteomics Distinguish Subtypes of NMO Spectrum Disorder and MOG Antibody-Associated Disease and Highlight Effects of B-Cell Depletion

“… 17 , 18 The effectiveness of BCD in SN-NMOSD is currently uncertain. 13 Consequently, the second objective of our study was to investigate whether BCD treatment leads to distinct alterations in serum proteomes for each NMOSD subtype.…”

“… 17 , 18 Limited information is available regarding BCD in SN-NMOSD; however, anti-CD20 may reduce relapse rates in these patients. 13 , 19 …”

“…10 An important contrast between AQP4-NMOSD and MOGAD lies in the effectiveness of B-cell depleting therapies (BCD). Multiple studies have demonstrated that BCD with anti-CD20 monoclonal antibodies [11][12][13][14] almost completely eliminates relapses in AQP4-NMOSD patients and BCD with anti-CD19 antibodies has gained regulatory approval for NMOSD. 15,16 However, in patients with MOGAD, the efficacy of anti-CD20 is lower when compared with AQP4-NMOSD, and some patients may experience relapses despite the total depletion of B cells.…”