[Failure of rituximab in relapsing neuromyelitis optica: case report with two-year prospective follow-up].
Neuromyelitis optica (Devic's disease, NMO) is an inflammatory disease of the central nervous system preferentially involving the spinal cord and optic nerves in either a monophasic or relapsing-remitting course. B-cell induced pathogenesis was recently described for NMO. Rituximab is a chimeric monoclonal antibody directed against the CD20 antigen, which causes depletion of B-cells. Rituximab might be effective in treatment of NMO. We report the two-year clinicoradiological and biological follow-up data from a patient included in July 2005 in a prospective trial of rituximab for severe NMO refractory to immunosuppressant therapy. Blood B-cell depletion after rituximab induction was maintained for 10 months. Seven attacks occurred during a two-year follow-up. EDSS increased from 7.0 to 8.0. Left visual acuity decreased from 20/20 degrees to 20/60 degrees. Spinal cord atrophy worsened.
Cassinotto
C
C
Service de neurologie, CHU La Meynard, 97200 Fort-de-France, Martinique, France. cassinotto@gmail.com
Joux
J
J
Chausson
N
N
Smadja
D
D
Cabre
P
P
D000328:Adult; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D058846:Antibodies, Monoclonal, Murine-Derived; D001284:Atrophy; D001402:B-Lymphocytes / Q000187:drug effects; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D018655:Lymphocyte Count; D008279:Magnetic Resonance Imaging; D009471:Neuromyelitis Optica / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology; D010951:Plasma Exchange; D011446:Prospective Studies; D011859:Radiography; D000069283:Rituximab; D013116:Spinal Cord / Q000473:pathology; D014792:Visual Acuity
D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D007166:Immunosuppressive Agents; D000069283:Rituximab