Effect of rituximab on disease activity in latin American patients with anti-aquaporin-4 (+) neuromyelitis optica spectrum disorder

Different doses of Rituximab for the therapy of Neuromyelitis optica spectrum disorder: A systematic review and meta-analysis

BACKGROUND

Neuromyelitis optica spectrum disease(NMOSD) is an autoimmune neurological disease that primarily affects the spinal cord, optic nerve, and periventricular organs. Rituximab plays an important role in the prevention of relapse in NMOSD. In this study, we evaluated the efficacy and safety of different doses of the anti-monoclonal antibody rituximab in NMOSD.

OBJECTS

Our study aimed to implement a meta-analysis to systematically assess the efficacy and safety of different doses of rituximab in the treatment of NMOSD.

METHODS

We searched Pubmed, Embase, the Cochrane Library, and Clinicaltrials.gov for relevant studies evaluating rituximab for NMOSD up to March 2022. Data were assessed using Review Manager 5.3 and Stata 14 softwares. Means and standard deviations(SD) were analyzed using random effects models with continuous outcomes. Risk radio was analyzed using random effects models with dichotomous outcomes.

RESULTS

We collected 576 patients from 17 studies. The endpoint of efficacy was the change in annual recurrence rate(ARR), expanded disability status scale (EDSS), and the number of patients free of relapse between pre-treatment and post-treatment of rituximab. We found that rituximab reduced ARR and EDSS, with a significant reduction in ARR(MD= -1.79, 95% CI: -3.18 ∼ -0.39, P= 0.01) and EDSS(MD= -1.35, 95% CI: -1.5 ∼ -1.19, P < 0.00001) at 100 mg intravenous infusion per week for 3 consecutive weeks, meanwhile making the number of patients free of relapse increased (RR= 24.61 [5.11, 118.55], P<0.0001) and being relatively safe and without serious adverse events(SAEs). In terms of safety, we compared and summarised the adverse events(AEs) and SAEs from 17 studies.

CONCLUSION

In this study, we found rituximab to be relatively safe and efficacious in the treatment of NMOSD, particularly at a dose of 100mg intravenous infusion per week for 3 consecutive weeks.

Impact of Rituximab on relapse rate and disability in an Ecuadorian cohort of patients with neuromyelitis optica spectrum disorders

BACKGROUND

Neuromyelitis Optica Spectrum Disorder (NMOSD) is a severe inflammatory demyelinating disease of the central nervous system that often causes disability. Based on evidence from prospective and retrospective studies, Rituximab (RTX) has been used as the first-line of therapy in NMOSD. Nevertheless, evidence of the impact of RTX on relapse rate and disability in Ecuadorian patients with NMOSD is lacking.

OBJECTIVE

To evaluate the impact of RTX in an Ecuadorian cohort of patients with NMOSD.

MATERIALS AND METHODS

A retrospective study was conducted in a cohort of patients with NMOSD who received treatment with RTX in a third-level hospital in Quito, Ecuador. Digital medical records of NMOSD patients were reviewed to attain sociodemographic data, disease characteristics, and treatment with RTX. The annualized relapse rate ARR, as well as the degree of disability measured through the expanded disability scale (EDSS), was established before and after treatment.

RESULTS

Twenty-three patients with NMOSD treated with RTX were included, the mean age of onset of the disease was 37.2 years (range, 13-64.5). The average duration of disease was 8.5 years (range, 1.3-34.4). Positivity for antibodies against aquaporin-4 (AQP4-IgG) was identified in 78% of the patients. The mean duration of the treatment with RTX was 40 months (range, 12-61). After the RTX therapy, the number of relapses was reduced in 91% (21/23) of cases. The annualized relapsed rate (ARR) was reduced with RTX from 1.89 to 0.12 (p <0.001). The mean EDSS was also reduced from 4.8 to 3.9 (p = 0.014). In all patients, the mean EDSS was reduced or stabilized with RTX. Overall, the drug was well tolerated, the most frequent adverse events were infections which were present in 65.2% of cases.

CONCLUSIONS

Though with the limitations of and observational study, our data support RTX effectiveness and safety in an Ecuadorian cohort of patients with NMOSD.