title: Treatment of neuromyelitis optica and neuromyelitis optica spectrum disorders with rituximab using a maintenance treatment regimen and close CD19 B cell monitoring. A six-year follow-up.
abstract: Neuromyelitis optinca (NMO) represents a serious demyelinating disease of the central nervous system selectively attacking the spinal cord and optic nerve. Early differential diagnosis from multiple sclerosis is of vital importance, as NMO mandates immunosuppressive and not immunomodulatory treatment. Rituximab has been recently introduced as a treatment option for NMO. However, optimal surrogate measures and treatment intervals are still unclear. Five patients (females, mean age 54±10.21years) with NMO and NMO spectrum disorders (NMOSD) were evaluated with respect to disability and relapse rate. All patients were found positive for NMO IgG. All patients (three with NMO and two with NMOSD, 1 patient with recurrent optic neuritis and 1 patient with recurrent myelitis) had received rituximab treatment for six years. One patient with NMOSD received cyclophosphamide prior to rituximab while two were misdiagnosed as multiple sclerosis and had received interferon treatment. All received rituximab infusion of 375mg/m2once per week for 4weeks and then every two months for the first two years and then every six months. B-cell counts were measured every two months and were kept in almost undetectable levels. No relapse was noted during the treatment period while EDSS score was improved in all patients. No severe adverse effects occurred during RTX treatment. Rituximab treatment on NMO and NMOSD patients showed significant improvement in disability and relapse-rate without any significant adverse effects.
authors.affiliation: Demyelinating Diseases Unit, Department of Neurology, Eginition Hospital, National and Kapodistrian University of Athens, Greece. Electronic address: evangelopoulos@yahoo.gr.
authors.forename: M E
authors.initials: ME
authors.lastname: Evangelopoulos
authors.affiliation: Demyelinating Diseases Unit, Department of Neurology, Eginition Hospital, National and Kapodistrian University of Athens, Greece.
authors.forename: E
authors.initials: E
authors.lastname: Andreadou
authors.affiliation: Demyelinating Diseases Unit, Department of Neurology, Eginition Hospital, National and Kapodistrian University of Athens, Greece.
authors.forename: G
authors.initials: G
authors.lastname: Koutsis
authors.affiliation: Department of Radiology, Aretaieion Hospital, National and Kapodistrian University of Athens, Greece.
authors.forename: V
authors.initials: V
authors.lastname: Koutoulidis
authors.affiliation: Demyelinating Diseases Unit, Department of Neurology, Eginition Hospital, National and Kapodistrian University of Athens, Greece.
authors.forename: M
authors.initials: M
authors.lastname: Anagnostouli
authors.affiliation: Demyelinating Diseases Unit, Department of Neurology, Eginition Hospital, National and Kapodistrian University of Athens, Greece.
authors.forename: P
authors.initials: P
authors.lastname: Katsika
authors.affiliation: 3rd Department of Orthopaedic Surgery, KAT Hospital, National and Kapodistrian University of Athens, Greece.
authors.forename: D S
authors.initials: DS
authors.lastname: Evangelopoulos
authors.affiliation: Demyelinating Diseases Unit, Department of Neurology, Eginition Hospital, National and Kapodistrian University of Athens, Greece.
authors.forename: I
authors.initials: I
authors.lastname: Evdokimidis
authors.affiliation: Demyelinating Diseases Unit, Department of Neurology, Eginition Hospital, National and Kapodistrian University of Athens, Greece.
authors.forename: C
authors.initials: C
authors.lastname: Kilidireas
mesh_terms: D000368:Aged; D018941:Antigens, CD19 / Q000378:metabolism*; D001323:Autoantibodies / Q000097:blood; D001402:B-Lymphocytes / Q000187:drug effects / Q000378:metabolism*; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use*; D008137:Longitudinal Studies; D008875:Middle Aged; D009471:Neuromyelitis Optica / Q000188:drug therapy* / Q000473:pathology*; D009900:Optic Nerve / Q000000981:diagnostic imaging; D012189:Retrospective Studies; D000069283:Rituximab / Q000627:therapeutic use*; D013116:Spinal Cord / Q000000981:diagnostic imaging
chemical_list: D018941:Antigens, CD19; D001323:Autoantibodies; C000604811:CD19 molecule, human; D007155:Immunologic Factors; D000069283:Rituximab
keywords: Neuromyelitis optica; Neuromyelitis optica spectrum disorders; Rituximab treatment