Prolonged Remission in Neuromyelitis Optica Following Cessation of Rituximab Treatment.
Neuromyelitis optica is an autoimmune disease characterized by acute episodes of transverse myelitis and optic neuritis. Several small, open-label studies suggest rituximab, a monoclonal antibody against CD20, prevents relapses in neuromyelitis optica; however, there is little consensus on timing or duration of treatment. Here we report four patients with severe relapsing neuromyelitis optica who were stabilized on rituximab and, after discontinuing treatment, continued to experience prolonged remission of their disease. Remission ranged from 4.5 to 10.5 years total, including 3 to 9 years off all therapies. The patients had sustained clinical responses despite normal B-lymphocyte levels and, in at least 2 patients, continued seropositivity for aquaporin-4 antibodies. These cases suggest that rituximab may induce prolonged remission in certain neuromyelitis optica patients, and they highlight the need for further elucidation of rituximab's mechanism in neuromyelitis optica.
School of Medicine, University of California, San Francisco, CA, USA Kelley.Weinfurtner@ucsf.edu.
Kelley
K
Weinfurtner
Department of Neurology, University of California, San Francisco, CA, USA.
Jennifer
J
Graves
Department of Neurology, University of Alabama, AL, USA.
Jayne
J
Ness
Lourie Center for Pediatric Multiple Sclerosis, Stony Brook University, NY, USA.
Lauren
L
Krupp
Lourie Center for Pediatric Multiple Sclerosis, Stony Brook University, NY, USA School of Nursing, State University of New York, Stony Brook, NY, USA.
Maria
M
Milazzo
Department of Neurology, University of California, San Francisco, CA, USA Department of Pediatrics, University of California, San Francisco, CA, USA.
Emmanuelle
E
Waubant
D051401:Aquaporin 4 / Q000378:metabolism; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007155:Immunologic Factors / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D009471:Neuromyelitis Optica / Q000188:drug therapy* / Q000503:physiopathology*; D012074:Remission Induction; D000069283:Rituximab / Q000008:administration & dosage*
C496030:AQP4 protein, human; D051401:Aquaporin 4; D007155:Immunologic Factors; D000069283:Rituximab
CNS demyelinating disease; neuromyelitis optica; rituximab