title: Impact of rituximab on relapse rate and disability in neuromyelitis optica.
abstract: BACKGROUND
  Neuromyelitis optica (NMO) is a severe demyelinating disease often leading to serious disability. Accumulating evidence now implicates humoral mechanisms in its pathogenesis. In the absence of an approved therapy, anti-inflammatory/immunosuppressant drugs have been used empirically for more than three decades. Recent evidence for a role of antibody to aquaporin-4 in the pathogenesis of NMO has led to the use of rituximab, a monoclonal antibody targeting the CD20 epitope on the entire B cell lineage.
  
  
  OBJECTIVE
  To evaluate the impact of rituximab on the relapse rate and disability in NMO.
  
  
  METHODS
  This is an IRB approved retrospective longitudinal study of NMO patients treated with rituximab.
  
  
  RESULTS
  We identified 53 patients with NMO, 23 of whom had been treated with rituximab. These patients (2 males, 21 females) had a mean age of 37.1 ± 14.6 years at the time of diagnosis. Eight of the 23 treated with rituximab were treatment naïve. All 23 were scheduled to receive infusions every six or 12 months after treatment initiation with a minimum follow-up of six months (median 32.5 months, range 7-63 months). Median relapse rate declined significantly from 1.87 relapses/patient per year to 0.0 relapses/patient per year. Kurtzke Expanded Disability Status Scale (EDSS) scores stabilized or improved in all patients. Use of rituximab is associated with a significant reduction in relapses and disability in patents with NMO.
authors.affiliation: Department of Neurology, University of Miami Miller School of Medicine, USA. gurdesh.bedi@scrmc.org
authors.forename: Gurdesh S
authors.initials: GS
authors.lastname: Bedi
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Brown
authors.forename: Sylvia R
authors.initials: SR
authors.lastname: Delgado
authors.forename: Nida
authors.initials: N
authors.lastname: Usmani
authors.forename: Byron L
authors.initials: BL
authors.lastname: Lam
authors.forename: William A
authors.initials: WA
authors.lastname: Sheremata
mesh_terms: D000328:Adult; D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use*; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use*; D008137:Longitudinal Studies; D008297:Male; D009471:Neuromyelitis Optica / Q000150:complications / Q000517:prevention & control*; D012189:Retrospective Studies; D000069283:Rituximab; D055502:Secondary Prevention; D016896:Treatment Outcome
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D007155:Immunologic Factors; D000069283:Rituximab