title: Treatment of neuromyelitis optica with rituximab: retrospective analysis of 25 patients.
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.
  
  
  METHODS
  Retrospective multicenter case series of NMO patients treated with rituximab.
  
  
  METHODS
  Seven tertiary medical centers in the United States and England.
  
  
  METHODS
  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.
  
  
  METHODS
  Infusions of rituximab at median intervals of 8 months.
  
  
  METHODS
  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, P < .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.
authors.affiliation: Mayo Clinic, Rochester, Minnesota, USA. anu.jacob@thewaltoncentre.nhs.uk
authors.forename: Anu
authors.initials: A
authors.lastname: Jacob
authors.forename: Brian G
authors.initials: BG
authors.lastname: Weinshenker
authors.forename: Ivo
authors.initials: I
authors.lastname: Violich
authors.forename: Nancy
authors.initials: N
authors.lastname: McLinskey
authors.forename: Lauren
authors.initials: L
authors.lastname: Krupp
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Fox
authors.forename: Dean M
authors.initials: DM
authors.lastname: Wingerchuk
authors.forename: Mike
authors.initials: M
authors.lastname: Boggild
authors.forename: Cris S
authors.initials: CS
authors.lastname: Constantinescu
authors.forename: Aaron
authors.initials: A
authors.lastname: Miller
authors.forename: Tracy
authors.initials: T
authors.lastname: De Angelis
authors.forename: Marcelo
authors.initials: M
authors.lastname: Matiello
authors.forename: Bruce A C
authors.initials: BA
authors.lastname: Cree
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000911:Antibodies, Monoclonal / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D058846:Antibodies, Monoclonal, Murine-Derived; D002648:Child; D004185:Disability Evaluation; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D007155:Immunologic Factors / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009471:Neuromyelitis Optica / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology; D012189:Retrospective Studies; D000069283:Rituximab; D055502:Secondary Prevention; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D007155:Immunologic Factors; D000069283:Rituximab