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Zheng Y, Sun C, Zhao Y, Meng Q, Hu J, Qiao K, Sun J, Xi J, Luo S, Lu J, Zhao C, Lin J. Long-term and low-dose rituximab treatment for chronic inflammatory demyelinating polyneuropathy. J Peripher Nerv Syst 2024; 29:350-355. [PMID: 39152723 DOI: 10.1111/jns.12653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 07/29/2024] [Accepted: 08/02/2024] [Indexed: 08/19/2024]
Abstract
OBJECTIVE To evaluate the efficacy and safety of a low-dose, long-term rituximab regimen in the treatment of idiopathic CIDP. METHODS This study included 15 CIDP patients treated with rituximab. Patients were administered 600 mg of rituximab intravenously every 6 months. Baseline evaluation was conducted before the initiation of rituximab treatment and subsequent evaluations were conducted 6 months after each rituximab infusion at on-site visits. Clinical improvement was objectively determined by improvement of scale score at least decrease ≥1 INCAT or mRS or increase ≥4 MRC or ≥8 cI-RODS after each infusion compared to baseline evaluation. RESULTS Fifteen CIDP patients were included and 10 of them were typical CIDP and five were distal CIDP. Nine in 15 (60%) patients after first infusion and three in six (50%) patients after second infusion exhibited significant clinical improvement compared to baseline evaluation. Additionally, rituximab facilitated a reduction or cessation of other medications in 73% of patients at last visit. The safety profile was favorable, with no reported adverse events. CONCLUSION Rituximab presents a promising therapeutic option for idiopathic CIDP, offering both efficacy and safety with a low-dose, long-term regimen.
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Affiliation(s)
- Yongsheng Zheng
- Department of Neurology, Huashan Hospital Fudan University, Shanghai, China
- National Center for Neurological Disorders (NCND), Shanghai, China
- Huashan Rare Disease Center, Huashan Hospital Fudan University, Shanghai, China
| | - Chong Sun
- Department of Neurology, Huashan Hospital Fudan University, Shanghai, China
- National Center for Neurological Disorders (NCND), Shanghai, China
- Huashan Rare Disease Center, Huashan Hospital Fudan University, Shanghai, China
| | - Yanyin Zhao
- Department of Neurology, Huashan Hospital Fudan University, Shanghai, China
- National Center for Neurological Disorders (NCND), Shanghai, China
- Huashan Rare Disease Center, Huashan Hospital Fudan University, Shanghai, China
| | - Quanhua Meng
- Department of Neurology, Deyang People's Hospital, Deyang, China
| | - Jianian Hu
- Department of Neurology, Huashan Hospital Fudan University, Shanghai, China
- National Center for Neurological Disorders (NCND), Shanghai, China
- Huashan Rare Disease Center, Huashan Hospital Fudan University, Shanghai, China
| | - Kai Qiao
- Department of Neurology, Huashan Hospital Fudan University, Shanghai, China
| | - Jian Sun
- Department of Neurology, Huashan Hospital Fudan University, Shanghai, China
| | - Jianying Xi
- Department of Neurology, Huashan Hospital Fudan University, Shanghai, China
- National Center for Neurological Disorders (NCND), Shanghai, China
- Huashan Rare Disease Center, Huashan Hospital Fudan University, Shanghai, China
| | - Sushan Luo
- Department of Neurology, Huashan Hospital Fudan University, Shanghai, China
- National Center for Neurological Disorders (NCND), Shanghai, China
- Huashan Rare Disease Center, Huashan Hospital Fudan University, Shanghai, China
| | - Jiahong Lu
- Department of Neurology, Huashan Hospital Fudan University, Shanghai, China
| | - Chongbo Zhao
- Department of Neurology, Huashan Hospital Fudan University, Shanghai, China
- National Center for Neurological Disorders (NCND), Shanghai, China
- Huashan Rare Disease Center, Huashan Hospital Fudan University, Shanghai, China
| | - Jie Lin
- Department of Neurology, Huashan Hospital Fudan University, Shanghai, China
- National Center for Neurological Disorders (NCND), Shanghai, China
- Huashan Rare Disease Center, Huashan Hospital Fudan University, Shanghai, China
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Alawneh I, Alenizi A, Paiz F, Nigro E, Vajsar J, Gonorazky H. Pediatric Chronic Inflammatory Demyelinating Polyneuropathy: Challenges in Diagnosis and Therapeutic Strategies. Paediatr Drugs 2024:10.1007/s40272-024-00646-6. [PMID: 39192168 DOI: 10.1007/s40272-024-00646-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/21/2024] [Indexed: 08/29/2024]
Abstract
Chronic inflammatory demyelinating polyneuropathy (CIDP) is a rare autoimmune neurological disorder seen in both pediatric and adult populations. CIDP typically presents with progressive and persistent weakness over at least 4 weeks in addition to sensory symptoms in the extremities. Although CIDP shares common clinical features between children and adults, it sometimes presents as a distinct clinical entity in children that requires close attention and recognition. A major caveat when diagnosing a child with CIDP is the clinical and diagnostic overlap with inherited neuropathies, most commonly Charcot-Marie-Tooth disease (CMT). Demyelinating CMT (dCMT) and CIDP might share similar clinical presentations, and sometimes it might be difficult to differentiate them on the basis of the electrodiagnostic findings or cerebrospinal fluid (CSF) albumino-cytological dissociation. This indeed merits early consideration for genetic testing in patients who do not respond to conventional CIDP therapies. Current treatment options for CIDP include intravenous immunoglobulins (IVIG), corticosteroids (CS), and plasmapheresis (PLEX). The need for novel therapies is essential in instances where patients continue to have symptoms despite the standard therapies or due to adverse effects of long-term use of standard therapies such as CS. This paper reviews the challenges in the diagnosis of CIDP in children and the current as well as novel therapies for CIDP.
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Affiliation(s)
- Issa Alawneh
- Division of Neurology, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Asmaa Alenizi
- Division of Neurology, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Freddy Paiz
- Division of Neurology, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Elisa Nigro
- Division of Neurology, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Jiri Vajsar
- Division of Neurology, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Hernan Gonorazky
- Division of Neurology, The Hospital for Sick Children, University of Toronto, Toronto, Canada.
- Program of Genetic and Genome Biology, The Hospital for Sick Children, University of Toronto, Toronto, Canada.
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Doneddu PE, Cocito D, Fazio R, Benedetti L, Peci E, Liberatore G, Falzone YM, Germano F, Gallia F, Giannotta C, Lleixà C, Bianchi E, Nobile-Orazio E. Prospective open-label trial with rituximab in patients with chronic inflammatory demyelinating polyradiculoneuropathy not responding to conventional immune therapies. J Neurol Neurosurg Psychiatry 2024; 95:838-844. [PMID: 38729746 DOI: 10.1136/jnnp-2023-332844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 02/13/2024] [Indexed: 05/12/2024]
Abstract
BACKGROUND To evaluate the efficacy of rituximab in chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) patients not responding to conventional immune therapies. METHODS An open-label, prospective exploratory study was conducted with intravenous rituximab on 17 CIDP patients who had not responded to at least two first-line therapies. The primary endpoint was to determine the proportion of patients who showed improvement 6 months after rituximab therapy. The percentage of responders to rituximab, along with a 95% CI, was reported and compared with the 30% response rate after other immunosuppressive drugs previously documented in the literature. RESULTS 13 of the 17 treated patients (76.5%) showed improvement at 6 months (95% CI 50.1 to 93.2). Among the 14 patients who completed the 12-month follow-up (2 were lost to follow-up after showing improvement at months 8 and 10, and 1 deteriorated at 6 months), 13 (92.9%) demonstrated improvement at 12 months (95% CI 66.1 to 99.8). Nerve conduction parameters improved by at least 20% in two nerves in 6 out of 15 (40%) patients at 6 months and in 7 out of 13 (53.9%) at 12 months. None of the treated patients withdrew from the study due to side effects. There was a significant reduction of circulating CD19+ cells 15 days, 2, 6 and 12 months after treatment. CONCLUSION Rituximab seems to be a safe therapy in most patients with CIDP not responding to conventional immune therapies. The high percentage of patients who improved in this study suggests a possible positive effect of rituximab which is worth investigating in future randomised controlled clinical trials. TRIAL REGISTRATION NUMBER NCT05877040.
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Affiliation(s)
- Pietro Emiliano Doneddu
- Neuromuscular and Neuroimmunology Unit, IRCCS Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Dario Cocito
- Dipartimento Scienze Cliniche e Biologiche, Università di Torino, Torino, Italy
| | - Raffaella Fazio
- Division of Neuroscience, Department of Neurology, Institute of Experimental Neurology (INSPE), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Erdita Peci
- Presidio Sanitario Major, Istituti Clinici Scientifici Maugeri, Torino, Italy
| | - Giuseppe Liberatore
- Neuromuscular and Neuroimmunology Unit, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Yuri Matteo Falzone
- Division of Neuroscience, Department of Neurology, Institute of Experimental Neurology (INSPE), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Germano
- IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Infantile Science (DINOGMI), Genoa University, Genova, Italy
| | - Francesca Gallia
- Neuromuscular and Neuroimmunology Unit, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Claudia Giannotta
- Neuromuscular and Neuroimmunology Unit, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Cinta Lleixà
- Department of Neurology, Neuromuscular Diseases Unit, Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Elisa Bianchi
- Laboratorio di Malattie Neurologiche, Istituto di ricerche farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Eduardo Nobile-Orazio
- Neuromuscular and Neuroimmunology Unit, IRCCS Humanitas Research Hospital, Milan, Italy
- Department of Medical Biotechnology and Translational Medicine, University of Milan, Milano, Italy
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Khandait PD, Rohatgi S, Nirhale SP, Rao PM, Naphade PU. Rituximab Therapy for Immune-Mediated Neurological Diseases: Our Experience at a Tertiary Care Centre. Cureus 2024; 16:e62227. [PMID: 39006634 PMCID: PMC11244719 DOI: 10.7759/cureus.62227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2024] [Accepted: 06/12/2024] [Indexed: 07/16/2024] Open
Abstract
INTRODUCTION Rituximab (RTX) is a monoclonal anti-CD20 chimeric antibody that inhibits B cell activity. However, it is an appealing substitute for traditional immunomodulatory drugs as a swiftly acting, targeted therapy with mounting evidence of efficacy and tolerance in numerous neuroinflammatory conditions. We discuss the scientific evidence for the use of RTX in neurological illnesses, as well as the dose, safety, and other practical elements of prescription. AIM This study aims to assess and correlate the effects of RTX on immune-mediated neurological disorders. OBJECTIVES The primary objective of this study is to determine the outcomes in patients treated with RTX for the following conditions: myasthenia gravis (MG), autoimmune encephalitis, multiple sclerosis (MS), neuromyelitis optica spectrum disorder (NMOSD), myelin oligodendrocyte glycoprotein antibody disease (MOGAD), immune-mediated peripheral neuropathy, and inflammatory muscle disease. The secondary objective is to assess adverse drug reactions in patients treated with RTX. METHODS This is a prospective observational study conducted at a tertiary care centre. The data were analyzed for the period from May 2022 to May 2024. Approval was obtained from the institutional ethics committee before commencing the study, and written informed consent was obtained from all patients. RESULTS AND CONCLUSIONS A total of 56 patients were included in the study. The distribution of patients according to diseases is as follows: MG (17), MS (11), NMOSD (10), MOGAD (7), immune-mediated peripheral neuropathy (6), autoimmune encephalitis (3), and inflammatory muscle disease (2). However, one patient was lost to follow-up in the autoimmune encephalitis group. All patients experienced improvements in symptoms, and no relapse episodes have been reported except for one patient who had a relapse in the inflammatory muscle disease group. During the infusion process, some adverse drug reactions, such as chills and rigors, were observed, and two patients experienced major side effects, such as Pott's disease and cryptogenic organizing pneumonia. Nevertheless, overall, rituximab shows promise as an off-label immunosuppressive treatment for the aforementioned neurological immune-mediated diseases.
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Affiliation(s)
- Pranit D Khandait
- Neurology, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pune, IND
| | - Shalesh Rohatgi
- Neurology, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pune, IND
| | - Satish P Nirhale
- Neurology, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pune, IND
| | - Prajwal M Rao
- Neurology, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pune, IND
| | - Pravin U Naphade
- Neurology, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pune, IND
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Jaime-Pérez JC, Meléndez-Flores JD, Ramos-Dávila EM, González-Treviño M, Gómez-Almaguer D. Hematopoietic stem cell transplantation for uncommon immune-mediated neurological disorders: A literature review. Cytotherapy 2022; 24:676-685. [DOI: 10.1016/j.jcyt.2021.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 12/14/2021] [Accepted: 12/18/2021] [Indexed: 11/17/2022]
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Rajabally YA. Contemporary challenges in the diagnosis and management of chronic inflammatory demyelinating polyneuropathy. Expert Rev Neurother 2022; 22:89-99. [PMID: 35098847 DOI: 10.1080/14737175.2022.2036125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Despite extensive research, multiple inter-related diagnostic and management challenges remain for chronic inflammatory demyelinating polyneuropathy (CIDP). AREAS COVERED A literature review was performed on diagnosis and treatment in CIDP. The clinical features and disease course were evaluated. Investigative techniques, including electrophysiology, cerebrospinal fluid examination, neuropathology, imaging and neuroimmunology, were considered in relation to technical aspects, sensitivity, specificity, availability and cost. Available evidenced-based treatments and those with possible efficacy despite lack of evidence, were considered, as well as current methods for evaluation of treatment effects. EXPERT OPINION CIDP remains a clinical diagnosis, supported first and foremost by electrophysiology. Other investigative techniques have limited impact. Most patients with CIDP respond to available first-line treatments and immunosuppression may be efficacious in those who do not. Consideration of the natural history and of the high reported remission rate, of under-recognised associated disabling features, of treatment administration modalities and assessment methods, require enhanced attention.
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Affiliation(s)
- Yusuf A Rajabally
- Inflammatory Neuropathy Clinic, Department of Neurology, University Hospitals Birmingham, Birmingham, UK.,Aston Medical School, Aston University, Birmingham, UK
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