Treatment of neuromyelitis optica with rituximab: retrospective analysis of 25 patients.
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.
Jacob
Anu
A
Mayo Clinic, Rochester, Minnesota, USA. anu.jacob@thewaltoncentre.nhs.uk
Weinshenker
Brian G
BG
Violich
Ivo
I
McLinskey
Nancy
N
Krupp
Lauren
L
Fox
Robert J
RJ
Wingerchuk
Dean M
DM
Boggild
Mike
M
Constantinescu
Cris S
CS
Miller
Aaron
A
De Angelis
Tracy
T
Matiello
Marcelo
M
Cree
Bruce A C
BA
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
D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D007155:Immunologic Factors; D000069283:Rituximab