title: Rituximab as a first-line preventive treatment in pediatric NMOSDs: Preliminary results in 5 children.
abstract: OBJECTIVE
  No established therapeutic protocol has been proposed to date for childhood-onset neuromyelitis optica (NMO) spectrum disorders (NMOSDs). We report the response of 5 NMO immunoglobulin (Ig)G-positive pediatric cases to a standardized B-cell-targeted first-line immunosuppressive protocol with rituximab for prevention of relapses.
  
  
  METHODS
  Retrospective observational cohort study.
  
  
  RESULTS
  All patients included in the study showed disease remission after rituximab induction. Relapses always occurred in conjunction with CD19(+) B-cell repopulation and appeared less severe than prior to treatment. At the end of follow-up, neurologic disability and MRI findings stabilized or improved in all the patients, with only minor and transient side effects. Oral steroid discontinuation was possible in all the patients.
  
  
  CONCLUSIONS
  Our protocol is well-tolerated and has provided encouraging results in terms of control of relapses and progression of disability. An early intervention with rituximab might affect the disease course in pediatric NMO-IgG-positive NMOSDs.
  
  
  METHODS
  This study provides Class IV evidence that for children with NMOSDs, rituximab is well-tolerated and stabilizes or improves neurologic disability.
authors.affiliation: Neuroimaging Research Unit, Institute of Experimental Neurology, and Department of Neurology, Division of Neuroscience (G.L., M.F.), San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy; Department of Pediatrics (G.L., E.A.Y.), University of Toronto, and Division of Neurology (G.L., E.A.Y.), The Hospital for Sick Children, Toronto, Ontario, Canada; and Division of Neurology (B.B.), Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA.
authors.forename: Giulia
authors.initials: G
authors.lastname: Longoni
authors.affiliation: Neuroimaging Research Unit, Institute of Experimental Neurology, and Department of Neurology, Division of Neuroscience (G.L., M.F.), San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy; Department of Pediatrics (G.L., E.A.Y.), University of Toronto, and Division of Neurology (G.L., E.A.Y.), The Hospital for Sick Children, Toronto, Ontario, Canada; and Division of Neurology (B.B.), Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA.
authors.forename: Brenda
authors.initials: B
authors.lastname: Banwell
authors.affiliation: Neuroimaging Research Unit, Institute of Experimental Neurology, and Department of Neurology, Division of Neuroscience (G.L., M.F.), San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy; Department of Pediatrics (G.L., E.A.Y.), University of Toronto, and Division of Neurology (G.L., E.A.Y.), The Hospital for Sick Children, Toronto, Ontario, Canada; and Division of Neurology (B.B.), Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA.
authors.forename: Massimo
authors.initials: M
authors.lastname: Filippi
authors.affiliation: Neuroimaging Research Unit, Institute of Experimental Neurology, and Department of Neurology, Division of Neuroscience (G.L., M.F.), San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy; Department of Pediatrics (G.L., E.A.Y.), University of Toronto, and Division of Neurology (G.L., E.A.Y.), The Hospital for Sick Children, Toronto, Ontario, Canada; and Division of Neurology (B.B.), Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA.
authors.forename: E Ann
authors.initials: EA
authors.lastname: Yeh