Long-term follow-up of patients with neuromyelitis optica after repeated therapy with rituximab
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- 12 April 2011
- journal article
- Published by Ovid Technologies (Wolters Kluwer Health) in Neurology
- Vol. 76 (15), 1310-1315
- https://doi.org/10.1212/wnl.0b013e3182152881
Abstract
Background: Neuromyelitis optica (NMO) is a severe autoimmune disease targeting optic nerves and spinal cord. The monoclonal anti-CD20 B-cell antibody rituximab is an emerging therapeutic option in NMO. However, neither long-term efficacy or safety of rituximab, nor the correlation between B-cell counts, B-cell fostering cytokines, aquaporin-4 antibodies (AQP4-ab), and disease activity in NMO, have been investigated prospectively. Methods: We performed a prospective long-term cohort study of 10 patients with NMO who were treated up to 5 times with rituximab as a second-line therapy. Clinical examinations, B-cell counts, and serum concentrations of BAFF (B-cell activating factor of the TNF family; also called TNFSF13b), APRIL (a proliferation-inducing ligand; also called TNFSF13), AQP4-ab, and immunoglobulin levels were measured every 3 months. Results: Repeated treatment with rituximab led to sustained clinical stabilization in most patients with NMO. Disease activity correlated with B-cell depletion, but not clearly with AQP4-ab or levels of APRIL. BAFF levels increased after application of rituximab and indicated persisting efficacy of the drug but did not correlate with disease activity. Overall, rituximab was well-tolerated even after up to 5 consecutive treatment courses; however, we observed several severe adverse reactions. Conclusion: Our data indicate that long-term therapy with rituximab is effective in NMO as a second-line therapy and has an acceptable safety profile. Retreatment with rituximab should be applied before reappearance of circulating B cells. Classification of evidence: This study provides Class IV evidence that repeated doses of rituximab result in stabilization in most patients.Keywords
This publication has 34 references indexed in Scilit:
- Rituximab add-on therapy for breakthrough relapsing multiple sclerosisNeurology, 2010
- Intra-cerebral injection of neuromyelitis optica immunoglobulin G and human complement produces neuromyelitis optica lesions in miceBrain, 2010
- Course of neuromyelitis optica during inadvertent pregnancy in a patient treated with rituximabMultiple Sclerosis Journal, 2009
- Intrathecal pathogenic anti–aquaporin‐4 antibodies in early neuromyelitis opticaAnnals of Neurology, 2009
- Aquaporin-4 autoimmune syndrome and anti-aquaporin-4 antibody-negative opticospinal multiple sclerosis in JapaneseMultiple Sclerosis Journal, 2009
- B cells as therapeutic targets in autoimmune neurological disordersNature Clinical Practice Neurology, 2008
- Antibody to aquaporin-4 in the long-term course of neuromyelitis opticaBrain, 2008
- Interferon-β increases BAFF levels in multiple sclerosis: implications for B cell autoimmunityBrain, 2008
- Increase of B cell-activating factor of the TNF family (BAFF) after rituximab treatment: insights into a new regulating system of BAFF productionAnnals Of The Rheumatic Diseases, 2007
- Immunosuppressive therapy is more effective than interferon in neuromyelitis opticaMultiple Sclerosis Journal, 2007