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01-04-2018 | Original Communication

Treatment of neuromyelitis optica with rituximab: a 2-year prospective multicenter study

Authors: Philippe Cabre, M. Mejdoubi, S. Jeannin, H. Merle, Y. Plumelle, G. Cavillon, D. Smadja, R. Marignier, On behalf of Francophone Society of Multiple Sclerosis and OFSEP investigators

Published in: Journal of Neurology | Issue 4/2018

Abstract

Objective

Neuromyelitis optica (NMO) is a very severe autoimmune disorder of the central nervous system. It affects young subjects and has a poor prognosis both on a functional and vital level. Therefore, it is imperative to reduce the frequency of relapses. The purpose of this study was to evaluate the clinical and neuroradiological effectiveness of rituximab (RTX) on active forms of NMO.

Methods

We conducted a 2-year open prospective multicenter study that included 32 patients treated with RTX at a dose of 375 mg/m²/week for 1 month. When the number of circulating CD19+ B cells reached 1%, a maintenance therapy was started, consisting of two infusions of 1 g of RTX, administered at a 15-day interval. The primary objective was to reduce the annual relapse rate (ARR), in comparison to that observed in the 2 years before treatment onset.

Results

Rituximab administration reduced the ARR from 1.34 to 0.56 (p = 0.0005). The average Expanded Disability Status Scale (EDSS) score significantly improved by 1.1 point, from 5.9 (2–9) to 4.8 (0–9) after 2 years (p = 0.03). Anti-aquaporin-4 antibodies’ level predicted treatment failure (p = 0.03). Frequency of Gad+ lesions in spinal cord decreased from 23.3 to 14.2%. RTX treatment did not prevent the death of three patients (treatment failure in two patients and acute myeloid leukemia in a patient previously treated with mitoxantrone).

Conclusion

Rituximab is clinically effective in active forms of NMO, although few patients are resistant to the treatment.

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Title: Treatment of neuromyelitis optica with rituximab: a 2-year prospective multicenter study
Authors: Philippe Cabre
M. Mejdoubi
S. Jeannin
H. Merle
Y. Plumelle
G. Cavillon
D. Smadja
R. Marignier
On behalf of Francophone Society of Multiple Sclerosis and OFSEP investigators
Publication date: 01-04-2018
Publisher: Springer Berlin Heidelberg
Published in: Journal of Neurology / Issue 4/2018
Print ISSN: 0340-5354
Electronic ISSN: 1432-1459
DOI: https://doi.org/10.1007/s00415-018-8771-5

At a glance: The STEP trials

Springer Medicine

Treatment of neuromyelitis optica with rituximab: a 2-year prospective multicenter study

Abstract

Objective

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Objective

Methods

Results

Conclusion

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