Interleukin 6 receptor blockade in patients with neuromyelitis optica nonresponsive to anti-CD20 therapy.
OBJECTIVE
To report first experiences with interleukin 6 receptor inhibition in therapy-resistant neuromyelitis optica (NMO).


METHODS
Retrospective case series.


METHODS
Neurology department at a tertiary referral center.


METHODS
Patients with an aggressive course of NMO switched to tocilizumab after failure of anti-CD20 therapy.


METHODS
Annualized relapse rate and disability progression measured by the Expanded Disability Status Scale.


RESULTS
We report 3 female patients with a median age of 39 years (range, 26-40 years) and aquaporin 4-positive NMO. All patients had been treated with different immunosuppressive and immunomodulating agents, followed by 1 to 3 cycles of rituximab. Despite complete CD20-cell depletion during rituximab therapy, the median annualized relapse rate was 3.0 (range, 2.3-3.0) and the median Expanded Disability Status Scale score increased from 5.0 (range, 4.5-7.0) to 6.5 (range, 5.0-7.0). After the switch to tocilizumab (median duration of therapy, 18 months), the median annualized relapse rate decreased to 0.6 (range, 0-1.3). A total of 2 relapses occurred; however, they were mild and there were no changes in clinical disability.


CONCLUSIONS
Interleukin 6 receptor-blocking therapy can be effective in therapy-resistant cases of NMO. Larger controlled studies are needed to confirm the efficacy of tocilizumab.
Department of Neurology,St Josef-Hospital, Ruhr-University Bochum, Bochum, Germany.
Ilya
I
Ayzenberg
Ingo
I
Kleiter
Alexandra
A
Schröder
Kerstin
K
Hellwig
Andrew
A
Chan
Takashi
T
Yamamura
Ralf
R
Gold
D000328:Adult; D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use; D018951:Antigens, CD20 / Q000276:immunology*; D005260:Female; D006801:Humans; D009471:Neuromyelitis Optica / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology*; D019947:Receptors, Interleukin-6 / Q000037:antagonists & inhibitors* / Q000502:physiology*; D012189:Retrospective Studies; D000069283:Rituximab; D016896:Treatment Outcome
D058846:Antibodies, Monoclonal, Murine-Derived; D018951:Antigens, CD20; D019947:Receptors, Interleukin-6; D000069283:Rituximab