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Xiao L, Huang Y, Sun H, Gao S, Huang D, Wu L. Rituximab maintenance treatment outcomes in patients with relapsing neuromyelitis optica spectrum disorder: a monocentric retrospective analysis. Acta Neurol Belg 2024:10.1007/s13760-024-02555-4. [PMID: 38858290 DOI: 10.1007/s13760-024-02555-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 04/07/2024] [Indexed: 06/12/2024]
Abstract
Some patients with neuromyelitis optica spectrum disorder (NMOSD) experience relapse after rituximab (RTX) treatment. In this retrospective study, we analyzed the recurrence-related clinical features, laboratory investigation results, and dosing protocol of 30 female patients with relapsing NMOSD with immunoglobulin G autoantibodies against aquaporin-4 and relapses during repeated 0.5 g RTX infusions as maintenance treatment. The median follow-up period was 6.62 years. Thirty-five episodes were observed, with myelitis being the most frequent. The median expanded disability status scale change score was 0.50. The recurrence rate decreased by 44.23%/year with RTX infusion. Approximately 85.71% of the patients showed relapse without RTX infusion within 10 months. Overall, RTX may be effective for relapsing NMOSD cases.
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Affiliation(s)
- Lianchen Xiao
- Department of Neurology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, China
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
| | - Yanning Huang
- School of Medicine, Nankai University, Tianjin, China
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
- Department of Neurology, The Secondary Medical Center, National Clinical Research Center for Geriatric Disease, Chinese PLA General Hospital, Beijing, China
| | - Hui Sun
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
| | - Sai Gao
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
| | - Dehui Huang
- Department of Neurology, Chinese PLA General Hospital, Beijing, China.
| | - Lei Wu
- Department of Neurology, Chinese PLA General Hospital, Beijing, China.
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2
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Tian G, Sun X, Chen W. Neuromyelitis Optica. Neuroophthalmology 2022. [DOI: 10.1007/978-981-19-4668-4_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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3
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Seyed Ahadi M, Naser Moghadasi A, Asgari N, Sahraian MA. Efficacy and safety of rituximab in patients with refractory neuromyelitis optica spectrum disorders: A prospective observation in Iranian cases. CASPIAN JOURNAL OF INTERNAL MEDICINE 2020; 11:155-162. [PMID: 32509243 PMCID: PMC7265520 DOI: 10.22088/cjim.11.2.155] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background: Rituximab has been used successfully in the recent years for treatment of neuromyelitis optica spectrum disorders (NMOSD). However, a uniform treatment protocol for maintenance therapy and the best interval for evaluation and retreatment have not been postulated. We evaluated the efficacy and safety of rituximab treatment as second line therapy, in Iranian patients with refractory NMOSD, based on annualized relapse rate (ARR) and expanded disability status scale (EDSS). Methods: In this prospective before-after study, a total of 18 patients were treated with a loading dose of rituximab (375 mg/m2 weekly in 4 consecutive weeks). Flow cytometric determination of CD19+ B cell in peripheral blood sample was carried every 6 weeks and patients were re-treated based on B cell repopulation with a single dose of 375 mg/m2. Wilcoxon signed rank test was used to evaluate the ARR and EDSS before and after treatment. A p-value of <0.05 was considered statistically significant. Results: Of the 18 patients, 10 (55.5%) were relapse-free during the period of follow up. The EDSS scores were reduced in nine (50%) patients and stable in the remaining nine (50%). The mean EDSS score before and after treatment were 4.1±0.4 and 3.7±0.3, respectively, which was statistically significant. There was also a statistically significant reduction in median ARR after treatment (1.48 (range 0.47-5) vs. 0 (range 0-2)). Rituximab administration did not have significant adverse effect in 94% of patients. Conclusion: Repeated treatment with Rituximab is an effective and well-tolerated treatment in refractory NMOSD.
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Affiliation(s)
- Maral Seyed Ahadi
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Abdorreza Naser Moghadasi
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Nasrin Asgari
- Institutes of Regional Health Research and Molecular Medicine, University of Southern Denmark
| | - Mohammad Ali Sahraian
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.,Iranian Center for Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
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Yang C, Yang Y, Ma L, Zhang GX, Shi FD, Yan Y, Chang G. Study of the cytological features of bone marrow mesenchymal stem cells from patients with neuromyelitis optica. Int J Mol Med 2019; 43:1395-1405. [PMID: 30628649 PMCID: PMC6365084 DOI: 10.3892/ijmm.2019.4056] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 01/04/2019] [Indexed: 12/22/2022] Open
Abstract
Neuromyelitis optica (NMO) is a refractory autoimmune inflammatory disease of the central nervous system without an effective cure. Autologous bone marrow-derived mesenchymal stem cells (BM-MSCs) are considered to be promising therapeutic agents for this disease due to their potential regenerative, immune regulatory and neurotrophic effects. However, little is known about the cytological features of BM-MSCs from patients with NMO, which may influence any therapeutic effects. The present study aimed to compare the proliferation, differentiation and senescence of BM-MSCs from patients with NMO with that of age- and sex-matched healthy subjects. It was revealed that there were no significant differences in terms of cell morphology or differentiation capacities in the BM-MSCs from the patients with NMO. However, in comparison with healthy controls, BM-MSCs derived from the Patients with NMO exhibited a decreased proliferation rate, in addition to a decreased expression of several cell cycle-promoting and proliferation-associated genes. Furthermore, the cell death rate increased in BM-MSCs from patients under normal culture conditions and an assessment of the gene expression profile further confirmed that the BM-MSCs from patients with NMO were more vulnerable to senescence. Platelet-derived growth factor (PDGF), as a major mitotic stimulatory factor for MSCs and a potent therapeutic cytokine in demyelinating disease, was able to overcome the decreased proliferation rate and increased senescence defects in BM-MSCs from the patients with NMO. Taken together, the results from the present study have enabled the proposition of the possibility of combining the application of autologous BM-MSCs and PDGF for refractory and severe patients with NMO in order to elicit improved therapeutic effects, or, at the least, to include PDGF as a necessary and standard growth factor in the current in vitro formula for the culture of NMO patient-derived BM-MSCs.
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Affiliation(s)
- Chunsheng Yang
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China
| | - Yang Yang
- Department of Biochemistry and Molecular Biology, Tianjin Medical University, Tianjin 300052, P.R. China
| | - Li Ma
- Department of Neurosurgery and Neuro‑Oncology, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin 300060, P.R. China
| | - Guang-Xian Zhang
- Department of Neurology, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Fu-Dong Shi
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China
| | - Yaping Yan
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China
| | - Guoqiang Chang
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China
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Notfälle in der Augenheilkunde. Notf Rett Med 2018. [DOI: 10.1007/s10049-018-0430-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Miao J, Aboagye DE, Chulpayev B, Liu L, Ishkanian G, Kolanuvada B, Alaie D, Petrillo RL. Importance of Regular and Maintenance Therapy Adherence in Neuromyelitis Optica (NMO): Lessons from a Repeating Relapse Case. AMERICAN JOURNAL OF CASE REPORTS 2018; 19:41-46. [PMID: 29321467 PMCID: PMC5772341 DOI: 10.12659/ajcr.906150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Patient: Female, 58 Final Diagnosis: NMO Symptoms: New-onset right leg weakness and pain Medication: — Clinical Procedure: Progressive and recurring Specialty: Neurology
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Affiliation(s)
- Jing Miao
- Department of Internal Medicine, Montefiore Mount Vernon Hospital, Mount Vernon, NY, USA
| | - Doreen E Aboagye
- Department of Internal Medicine, Montefiore Mount Vernon Hospital, Mount Vernon, NY, USA
| | - Boris Chulpayev
- Department of Internal Medicine, Montefiore Mount Vernon Hospital, Mount Vernon, NY, USA
| | - Lin Liu
- Department of Internal Medicine, Montefiore Mount Vernon Hospital, Mount Vernon, NY, USA
| | - Gary Ishkanian
- Department of Internal Medicine, Montefiore Mount Vernon Hospital, Mount Vernon, NY, USA
| | - Bangaruraju Kolanuvada
- Department of Internal Medicine, Montefiore Mount Vernon Hospital, Mount Vernon, NY, USA
| | - Dariush Alaie
- Department of Internal Medicine, Montefiore Mount Vernon Hospital, Mount Vernon, NY, USA
| | - Richard L Petrillo
- Department of Internal Medicine, Montefiore Mount Vernon Hospital, Mount Vernon, NY, USA
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Abstract
Neuromyelitis optica (NMO) is an autoimmune demyelinating disease with pathogenic autoantibodies that act against the astrocyte water channel protein, i.e. aquaporin-4: the disease is associated with recurrent episodes of optic neuritis (ON) and transverse myelitis, often resulting in severe disability. The main goals in treatment of NMO include acute symptomatic therapy and long-term stabilization of symptoms by preventing relapse. In recent years, ongoing randomized controlled trials in NMO patients have studied evidence for treatment. Briefly, acute-stage management (with pulse therapy using corticosteroids and/or plasmapheresis) and maintenance therapy (including rituximab, mycophenolate mofetil, and azathioprine) have been recommended in some case series and retrospective studies. Because of the high prevalence of liver disease, all NMO patients in Taiwan should be screened for hepatitis B and C before treatment is initiated. Although immunosuppression and plasma exchange are the mainstays of therapy for NMO ON, several selective and potentially therapeutic strategies targeting specific steps in NMO pathogenesis including blockers of NMO-IgG binding and inhibitors of granulocyte function have been evaluated in recent years.
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Affiliation(s)
- Tzu-Lun Huang
- Department of Ophthalmology, Far Eastern Memorial Hospital, New Taipei, Taiwan.,Department of Electrical Engineering, Yuan Ze University, Taoyuan, Taiwan
| | - Kung-Hung Lin
- Department of Neurology, Taiwan Adventist Hospital, Taipei, Taiwan
| | - Jia-Kang Wang
- Department of Ophthalmology, Far Eastern Memorial Hospital, New Taipei, Taiwan.,Department of Electrical Engineering, Yuan Ze University, Taoyuan, Taiwan
| | - Rong-Kung Tsai
- Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan.,Institute of Eye Research, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
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Choi JH, Wallach AI, Rosales D, Margiewicz SE, Belmont HM, Lucchinetti CF, Minen MT. Clinical Reasoning: A 50-year-old woman with SLE and a tumefactive lesion. Neurology 2017; 89:e140-e145. [DOI: 10.1212/wnl.0000000000004386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Mikhail M, Khan A. RETINAL VASCULITIS ASSOCIATED WITH NEUROMYELITIS OPTICA. Retin Cases Brief Rep 2017; 11 Suppl 1:S211-S215. [PMID: 27820753 DOI: 10.1097/icb.0000000000000445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
PURPOSE To report a case of retinal vasculitis in a patient with neuromyelitis optica. METHODS Clinical case report, imaging was obtained with photographs, fluorescein angiography, spectral domain optical coherence tomography, and magnetic resonance imaging. RESULTS The aforementioned patient presented with urinary incontinence and spastic paraparesis. She was found to have a transverse myelitis on magnetic resonance imaging and positive anti-aquaporin-4 (AQP4-Ab) testing. She had no associated visual symptoms. Examination revealed a retinal vasculitis. There have been no previous reports of retinal vasculitis associated with neuromyelitis optica or neuromyelitis optica spectrum disorder. CONCLUSION Retinal vasculitis can be associated with neuromyelitis optica.
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Affiliation(s)
- Mikel Mikhail
- Department of Ophthalmology, McGill University, Montreal, Quebec, Canada
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Valentino P, Marnetto F, Granieri L, Capobianco M, Bertolotto A. Aquaporin-4 antibody titration in NMO patients treated with rituximab: A retrospective study. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2016; 4:e317. [PMID: 28054001 PMCID: PMC5182057 DOI: 10.1212/nxi.0000000000000317] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 11/01/2016] [Indexed: 11/28/2022]
Abstract
Objective: We undertook an observational retrospective study to investigate the usefulness of aquaporin-4 (AQP4) antibodies (Ab) titration in the management of patients with neuromyelitis optica (NMO) treated with rituximab (RTX) by studying (1) the correlation between AQP4-Ab titer and disease activity, (2) the influence of RTX on antibody levels, and (3) the association between AQP4-Ab levels and responsiveness to RTX. Methods: A cell-based assay was used for AQP4-Ab titration in 322 serum samples from 7 patients with NMO treated with RTX (median follow-up 65 months), according to a treatment-to-target approach. Serum samples were collected every month following standardized procedures. Results: (1) In group analysis, AQP4-Ab titers correlated with the disease activity, showing higher titers during and preceding relapses than during remission. However, in individual analysis, an increase in AQP4-Ab titers and CD19+ B cells did not always precede a relapse. (2) A reduction of AQP4-Ab titers in the short-term and long-term period was observed during RTX treatment. (3) Reduction of AQP4-Ab titers was observed in responder patients both 3 months after RTX infusion and in the long-term follow-up. In one nonresponder patient, AQP4-Ab levels never decreased during the treatment period. Conclusions: Titration of AQP4-Abs could be useful in the clinical management of patients with NMO treated with RTX: titration before each reinfusion and 3 months after each reinfusion may provide information about responsiveness to RTX. Although a relationship among AQP4-Ab levels, disease activity, and response to RTX was observed, the usefulness of AQP4-Ab titration to predict relapses is limited.
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Affiliation(s)
- Paola Valentino
- Neuroscience Institute Cavalieri Ottolenghi (NICO) (P.V., F.M., L.G., A.B.) and Neurologia 2-CRESM (P.V., F.M., L.G., M.C., A.B.), AOU San Luigi Gonzaga, Orbassano, Turin, Italy
| | - Fabiana Marnetto
- Neuroscience Institute Cavalieri Ottolenghi (NICO) (P.V., F.M., L.G., A.B.) and Neurologia 2-CRESM (P.V., F.M., L.G., M.C., A.B.), AOU San Luigi Gonzaga, Orbassano, Turin, Italy
| | - Letizia Granieri
- Neuroscience Institute Cavalieri Ottolenghi (NICO) (P.V., F.M., L.G., A.B.) and Neurologia 2-CRESM (P.V., F.M., L.G., M.C., A.B.), AOU San Luigi Gonzaga, Orbassano, Turin, Italy
| | - Marco Capobianco
- Neuroscience Institute Cavalieri Ottolenghi (NICO) (P.V., F.M., L.G., A.B.) and Neurologia 2-CRESM (P.V., F.M., L.G., M.C., A.B.), AOU San Luigi Gonzaga, Orbassano, Turin, Italy
| | - Antonio Bertolotto
- Neuroscience Institute Cavalieri Ottolenghi (NICO) (P.V., F.M., L.G., A.B.) and Neurologia 2-CRESM (P.V., F.M., L.G., M.C., A.B.), AOU San Luigi Gonzaga, Orbassano, Turin, Italy
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Wan H, He H, Zhang F, Sha Y, Tian G. Diffusion-weighted imaging helps differentiate multiple sclerosis and neuromyelitis optica-related acute optic neuritis. J Magn Reson Imaging 2016; 45:1780-1785. [PMID: 27859858 DOI: 10.1002/jmri.25528] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 10/11/2016] [Indexed: 11/11/2022] Open
Affiliation(s)
- Hailin Wan
- Department of Radiology, Shanghai Pudong Hospital; Fudan University; Shanghai China
| | - Huijin He
- Department of Radiology, Shanghai Pudong Hospital; Fudan University; Shanghai China
| | - Fang Zhang
- Department of Radiology, Eye & ENT Hospital; Fudan University; Shanghai China
| | - Yan Sha
- Department of Radiology, Eye & ENT Hospital; Fudan University; Shanghai China
| | - Guohong Tian
- Department of Ophthalmology, Eye & ENT Hospital; Fudan University; Shanghai China
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Lin J, Xue B, Chen Z, Huang X, Pang W, Quan W, Huang Y, Li X, Xia J. Effects of early using azathioprine in the acute phase in neuromyelitis optica spectrum disorder. Int J Neurosci 2016; 127:508-515. [DOI: 10.1080/00207454.2016.1201665] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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