title: A 5-year follow-up of rituximab treatment in patients with neuromyelitis optica spectrum disorder.
abstract: OBJECTIVE
  A previous 2-year analysis of repeated rituximab treatment in patients with neuromyelitis optica (NMO) revealed significant improvements in relapse rates and disability. We report the findings from the longest follow-up of rituximab treatment in NMO, which provide reassurance regarding the long-term efficacy and safety of rituximab in NMO.
  
  
  OBJECTIVE
  To report the results of rituximab treatment in patients with relapsing NMO or NMO spectrum disorder (NMOSD) for a median of 60 months.
  
  
  METHODS
  Retrospective case series in an institutional referral center for multiple sclerosis, including 30 patients with relapsing NMO or NMOSD.
  
  
  METHODS
  After induction therapy, a single infusion of rituximab (375 mg/m2) as maintenance therapy was administered whenever the frequency of reemerging CD27+ memory B cells in peripheral blood mononuclear cells, as measured with flow cytometry, exceeded 0.05%in the first 2 years and 0.1% thereafter.
  
  
  METHODS
  Annualized relapse rate (ARR), disability (Expanded Disability Status Scale score), change in anti–aquaporin 4 antibody, and safety of rituximab treatment.
  
  
  RESULTS
  Of 30 patients, 26 (87%) exhibited a marked reduction in ARR over 5 years (mean [SD] pretreatment vs posttreatment ARR, 2.4 [1.5] vs 0.3 [1.0]). Eighteen patients (60%) became relapse free after rituximab treatment. In 28 patients (93%), the disability was either improved or stabilized after rituximab treatment. No serious adverse events leading to discontinuation were observed during follow-up.
  
  
  CONCLUSIONS
  Repeated treatment with rituximab in patients with NMOSD over a 5-period, using an individualized dosing schedule according to the frequency of reemerging CD27+ memory B cells, leads to a sustained clinical response with no new adverse events.
authors.forename: Su-Hyun
authors.initials: SH
authors.lastname: Kim
authors.forename: So-Young
authors.initials: SY
authors.lastname: Huh
authors.forename: Sun Ju
authors.initials: SJ
authors.lastname: Lee
authors.forename: AeRan
authors.initials: A
authors.lastname: Joung
authors.forename: Ho Jin
authors.initials: HJ
authors.lastname: Kim
mesh_terms: D000328:Adult; D058846:Antibodies, Monoclonal, Murine-Derived / Q000009:adverse effects / Q000627:therapeutic use*; D051401:Aquaporin 4 / Q000276:immunology; D001402:B-Lymphocytes / Q000187:drug effects / Q000276:immunology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009471:Neuromyelitis Optica / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology; D012189:Retrospective Studies; D000069283:Rituximab; D055502:Secondary Prevention; D016896:Treatment Outcome; D018127:Tumor Necrosis Factor Receptor Superfamily, Member 7 / Q000378:metabolism; D055815:Young Adult
chemical_list: C496030:AQP4 protein, human; D058846:Antibodies, Monoclonal, Murine-Derived; D051401:Aquaporin 4; D018127:Tumor Necrosis Factor Receptor Superfamily, Member 7; D000069283:Rituximab