1
|
Yong HYF, Burton JM. A Clinical Approach to Existing and Emerging Therapeutics in Neuromyelitis Optica Spectrum Disorder. Curr Neurol Neurosci Rep 2023; 23:489-506. [PMID: 37540387 DOI: 10.1007/s11910-023-01287-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2023] [Indexed: 08/05/2023]
Abstract
PURPOSE OF REVIEW Neuromyelitis optica spectrum disorder (NMOSD) is a rare but highly disabling disease of the central nervous system. Unlike multiple sclerosis, disability in NMOSD occurs secondary to relapses that, not uncommonly, lead to blindness, paralysis, and death. Recently, newer, targeted immunotherapies have been trialed and are now in the treatment arsenal. We have endeavoured to evaluate the current state of NMOSD therapeutics. RECENT FINDINGS This review provides a pragmatic evaluation of recent clinical trials and post-marketing data for rituximab, inebilizumab, satralizumab, eculizumab, and ravalizumab, contrasted to older agents. We also review contemporary issues such as treatment in the context of SARS-CoV2 infection and pregnancy. There has been a dramatic shift in NMOSD morbidity and mortality with earlier and improved disease recognition, diagnostic accuracy, and the advent of more effective, targeted therapies. Choosing a maintenance therapy remains nuanced depending on patient factors and accessibility. With over 100 putative agents in trials, disease-free survival is now a realistic goal for NMOSD patients.
Collapse
Affiliation(s)
- Heather Y F Yong
- Division of Neurology, Department of Clinical Neurosciences, University of Calgary, Cummings School of Medicine, Calgary, AB, Canada
| | - Jodie M Burton
- Division of Neurology, Department of Clinical Neurosciences, University of Calgary, Cummings School of Medicine, Calgary, AB, Canada.
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.
| |
Collapse
|
2
|
Demuth S, Collongues N, Audoin B, Ayrignac X, Bourre B, Ciron J, Cohen M, Deschamps R, Durand-Dubief F, Maillart E, Papeix C, Ruet A, Zephir H, Marignier R, De Seze J. Rituximab De-escalation in Patients With Neuromyelitis Optica Spectrum Disorder. Neurology 2023; 101:e438-e450. [PMID: 37290967 PMCID: PMC10435052 DOI: 10.1212/wnl.0000000000207443] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 04/07/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Exit strategies such as de-escalations have not been evaluated for rituximab in patients with neuromyelitis optica spectrum disorder (NMOSD). We hypothesized that they are associated with disease reactivations and aimed to estimate this risk. METHODS We describe a case series of real-world de-escalations from the French NMOSD registry (NOMADMUS). All patients met the 2015 International Panel for NMO Diagnosis (IPND) diagnostic criteria for NMOSD. A computerized screening of the registry extracted patients with rituximab de-escalations and at least 12 months of subsequent follow-up. We searched for 7 de-escalation regimens: scheduled discontinuations or switches to an oral treatment after single infusion cycles, scheduled discontinuations or switches to an oral treatment after periodic infusions, de-escalations before pregnancies, de-escalations after tolerance issues, and increased infusion intervals. Rituximab discontinuations motivated by inefficacy or for unknown purposes were excluded. The primary outcome was the absolute risk of NMOSD reactivation (one or more relapses) at 12 months. AQP4+ and AQP4- serotypes were analyzed separately. RESULTS We identified 137 rituximab de-escalations between 2006 and 2019 that corresponded to a predefined group: 13 discontinuations after a single infusion cycle, 6 switches to an oral treatment after a single infusion cycle, 9 discontinuations after periodic infusions, 5 switches to an oral treatment after periodic infusions, 4 de-escalations before pregnancies, 9 de-escalations after tolerance issues, and 91 increased infusion intervals. No group remained relapse-free over the whole de-escalation follow-up (mean: 3.2 years; range: 0.79-9.5), except pregnancies in AQP+ patients. In all groups combined and within 12 months, reactivations occurred after 11/119 de-escalations in patients with AQP4+ NMOSD (9.2%, 95% CI [4.7-15.9]), from 0.69 to 10.0 months, and in 5/18 de-escalations in patients with AQP4- NMOSD (27.8%, 95% CI [9.7-53.5]), from 1.1 to 9.9 months. DISCUSSION There is a risk of NMOSD reactivation whatever the rituximab de-escalation regimen. TRIAL REGISTRATION INFORMATION Registered on ClinicalTrials.gov: NCT02850705. CLASSIFICATION OF EVIDENCE This study provides Class IV evidence that de-escalation of rituximab increases the probability of disease reactivation.
Collapse
Affiliation(s)
- Stanislas Demuth
- From the Department of Neurology (S.D., N.C., J.D.S.); Clinical Investigation Center (N.C., J.D.S.), Strasbourg University Hospital; Department of Neurology (B.A.), APHM, Hôpital de la Timone, Pôle de Neurosciences Cliniques, Marseille; Department of Neurology (X.A.), Montpellier University Hospital; Department of Neurology (B.B.), Rouen University Hospital; Department of Neurology CRC-SEP (J.C.), CHU Toulouse; Department of Neurology, CHU Poitiers (J.C.); Department of Neurology (M.C.), CHU de Nice, UR2CA-URRIS, Nice Côte d'Azur University; Department of Neurology (R.D.), Hôpital Fondation Adolphe de Rothschild, Paris; Department of Neurology (F.D.U.R.A.N.D.-D.U.B.I.E.F.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Hôpital Neurologique, Hospices Civils de Lyon; Department of Neurology (E.M., C.P.), AP-HP, Pitié-Salpêtrière Hospital, Paris; Department of Neurology (Groupe Hospitalier Pellegrin) (A.R.), Centre Hospitalier Universitaire de Bordeaux; Université de Bordeaux (A.R.), INSERM U1215, Neurocentre Magendie; Department of Neurology (H.Z.), University Hospital of Lille, UFR3S Univ-Lille, Inserm U 1172; Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro Inflammation (R.M.), and Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (MIRCEM), Hôpital Neurologique Pierre Wertheimer, Bron; Centre des Neurosciences de Lyon-FORGETTING Team (R.M.), INSERM 1028 and CNRS UMR5292; and Université Claude Bernard Lyon 1 (R.M.), France
| | - Nicolas Collongues
- From the Department of Neurology (S.D., N.C., J.D.S.); Clinical Investigation Center (N.C., J.D.S.), Strasbourg University Hospital; Department of Neurology (B.A.), APHM, Hôpital de la Timone, Pôle de Neurosciences Cliniques, Marseille; Department of Neurology (X.A.), Montpellier University Hospital; Department of Neurology (B.B.), Rouen University Hospital; Department of Neurology CRC-SEP (J.C.), CHU Toulouse; Department of Neurology, CHU Poitiers (J.C.); Department of Neurology (M.C.), CHU de Nice, UR2CA-URRIS, Nice Côte d'Azur University; Department of Neurology (R.D.), Hôpital Fondation Adolphe de Rothschild, Paris; Department of Neurology (F.D.U.R.A.N.D.-D.U.B.I.E.F.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Hôpital Neurologique, Hospices Civils de Lyon; Department of Neurology (E.M., C.P.), AP-HP, Pitié-Salpêtrière Hospital, Paris; Department of Neurology (Groupe Hospitalier Pellegrin) (A.R.), Centre Hospitalier Universitaire de Bordeaux; Université de Bordeaux (A.R.), INSERM U1215, Neurocentre Magendie; Department of Neurology (H.Z.), University Hospital of Lille, UFR3S Univ-Lille, Inserm U 1172; Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro Inflammation (R.M.), and Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (MIRCEM), Hôpital Neurologique Pierre Wertheimer, Bron; Centre des Neurosciences de Lyon-FORGETTING Team (R.M.), INSERM 1028 and CNRS UMR5292; and Université Claude Bernard Lyon 1 (R.M.), France
| | - Bertrand Audoin
- From the Department of Neurology (S.D., N.C., J.D.S.); Clinical Investigation Center (N.C., J.D.S.), Strasbourg University Hospital; Department of Neurology (B.A.), APHM, Hôpital de la Timone, Pôle de Neurosciences Cliniques, Marseille; Department of Neurology (X.A.), Montpellier University Hospital; Department of Neurology (B.B.), Rouen University Hospital; Department of Neurology CRC-SEP (J.C.), CHU Toulouse; Department of Neurology, CHU Poitiers (J.C.); Department of Neurology (M.C.), CHU de Nice, UR2CA-URRIS, Nice Côte d'Azur University; Department of Neurology (R.D.), Hôpital Fondation Adolphe de Rothschild, Paris; Department of Neurology (F.D.U.R.A.N.D.-D.U.B.I.E.F.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Hôpital Neurologique, Hospices Civils de Lyon; Department of Neurology (E.M., C.P.), AP-HP, Pitié-Salpêtrière Hospital, Paris; Department of Neurology (Groupe Hospitalier Pellegrin) (A.R.), Centre Hospitalier Universitaire de Bordeaux; Université de Bordeaux (A.R.), INSERM U1215, Neurocentre Magendie; Department of Neurology (H.Z.), University Hospital of Lille, UFR3S Univ-Lille, Inserm U 1172; Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro Inflammation (R.M.), and Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (MIRCEM), Hôpital Neurologique Pierre Wertheimer, Bron; Centre des Neurosciences de Lyon-FORGETTING Team (R.M.), INSERM 1028 and CNRS UMR5292; and Université Claude Bernard Lyon 1 (R.M.), France
| | - Xavier Ayrignac
- From the Department of Neurology (S.D., N.C., J.D.S.); Clinical Investigation Center (N.C., J.D.S.), Strasbourg University Hospital; Department of Neurology (B.A.), APHM, Hôpital de la Timone, Pôle de Neurosciences Cliniques, Marseille; Department of Neurology (X.A.), Montpellier University Hospital; Department of Neurology (B.B.), Rouen University Hospital; Department of Neurology CRC-SEP (J.C.), CHU Toulouse; Department of Neurology, CHU Poitiers (J.C.); Department of Neurology (M.C.), CHU de Nice, UR2CA-URRIS, Nice Côte d'Azur University; Department of Neurology (R.D.), Hôpital Fondation Adolphe de Rothschild, Paris; Department of Neurology (F.D.U.R.A.N.D.-D.U.B.I.E.F.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Hôpital Neurologique, Hospices Civils de Lyon; Department of Neurology (E.M., C.P.), AP-HP, Pitié-Salpêtrière Hospital, Paris; Department of Neurology (Groupe Hospitalier Pellegrin) (A.R.), Centre Hospitalier Universitaire de Bordeaux; Université de Bordeaux (A.R.), INSERM U1215, Neurocentre Magendie; Department of Neurology (H.Z.), University Hospital of Lille, UFR3S Univ-Lille, Inserm U 1172; Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro Inflammation (R.M.), and Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (MIRCEM), Hôpital Neurologique Pierre Wertheimer, Bron; Centre des Neurosciences de Lyon-FORGETTING Team (R.M.), INSERM 1028 and CNRS UMR5292; and Université Claude Bernard Lyon 1 (R.M.), France
| | - Bertrand Bourre
- From the Department of Neurology (S.D., N.C., J.D.S.); Clinical Investigation Center (N.C., J.D.S.), Strasbourg University Hospital; Department of Neurology (B.A.), APHM, Hôpital de la Timone, Pôle de Neurosciences Cliniques, Marseille; Department of Neurology (X.A.), Montpellier University Hospital; Department of Neurology (B.B.), Rouen University Hospital; Department of Neurology CRC-SEP (J.C.), CHU Toulouse; Department of Neurology, CHU Poitiers (J.C.); Department of Neurology (M.C.), CHU de Nice, UR2CA-URRIS, Nice Côte d'Azur University; Department of Neurology (R.D.), Hôpital Fondation Adolphe de Rothschild, Paris; Department of Neurology (F.D.U.R.A.N.D.-D.U.B.I.E.F.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Hôpital Neurologique, Hospices Civils de Lyon; Department of Neurology (E.M., C.P.), AP-HP, Pitié-Salpêtrière Hospital, Paris; Department of Neurology (Groupe Hospitalier Pellegrin) (A.R.), Centre Hospitalier Universitaire de Bordeaux; Université de Bordeaux (A.R.), INSERM U1215, Neurocentre Magendie; Department of Neurology (H.Z.), University Hospital of Lille, UFR3S Univ-Lille, Inserm U 1172; Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro Inflammation (R.M.), and Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (MIRCEM), Hôpital Neurologique Pierre Wertheimer, Bron; Centre des Neurosciences de Lyon-FORGETTING Team (R.M.), INSERM 1028 and CNRS UMR5292; and Université Claude Bernard Lyon 1 (R.M.), France
| | - Jonathan Ciron
- From the Department of Neurology (S.D., N.C., J.D.S.); Clinical Investigation Center (N.C., J.D.S.), Strasbourg University Hospital; Department of Neurology (B.A.), APHM, Hôpital de la Timone, Pôle de Neurosciences Cliniques, Marseille; Department of Neurology (X.A.), Montpellier University Hospital; Department of Neurology (B.B.), Rouen University Hospital; Department of Neurology CRC-SEP (J.C.), CHU Toulouse; Department of Neurology, CHU Poitiers (J.C.); Department of Neurology (M.C.), CHU de Nice, UR2CA-URRIS, Nice Côte d'Azur University; Department of Neurology (R.D.), Hôpital Fondation Adolphe de Rothschild, Paris; Department of Neurology (F.D.U.R.A.N.D.-D.U.B.I.E.F.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Hôpital Neurologique, Hospices Civils de Lyon; Department of Neurology (E.M., C.P.), AP-HP, Pitié-Salpêtrière Hospital, Paris; Department of Neurology (Groupe Hospitalier Pellegrin) (A.R.), Centre Hospitalier Universitaire de Bordeaux; Université de Bordeaux (A.R.), INSERM U1215, Neurocentre Magendie; Department of Neurology (H.Z.), University Hospital of Lille, UFR3S Univ-Lille, Inserm U 1172; Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro Inflammation (R.M.), and Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (MIRCEM), Hôpital Neurologique Pierre Wertheimer, Bron; Centre des Neurosciences de Lyon-FORGETTING Team (R.M.), INSERM 1028 and CNRS UMR5292; and Université Claude Bernard Lyon 1 (R.M.), France
| | - Mikael Cohen
- From the Department of Neurology (S.D., N.C., J.D.S.); Clinical Investigation Center (N.C., J.D.S.), Strasbourg University Hospital; Department of Neurology (B.A.), APHM, Hôpital de la Timone, Pôle de Neurosciences Cliniques, Marseille; Department of Neurology (X.A.), Montpellier University Hospital; Department of Neurology (B.B.), Rouen University Hospital; Department of Neurology CRC-SEP (J.C.), CHU Toulouse; Department of Neurology, CHU Poitiers (J.C.); Department of Neurology (M.C.), CHU de Nice, UR2CA-URRIS, Nice Côte d'Azur University; Department of Neurology (R.D.), Hôpital Fondation Adolphe de Rothschild, Paris; Department of Neurology (F.D.U.R.A.N.D.-D.U.B.I.E.F.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Hôpital Neurologique, Hospices Civils de Lyon; Department of Neurology (E.M., C.P.), AP-HP, Pitié-Salpêtrière Hospital, Paris; Department of Neurology (Groupe Hospitalier Pellegrin) (A.R.), Centre Hospitalier Universitaire de Bordeaux; Université de Bordeaux (A.R.), INSERM U1215, Neurocentre Magendie; Department of Neurology (H.Z.), University Hospital of Lille, UFR3S Univ-Lille, Inserm U 1172; Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro Inflammation (R.M.), and Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (MIRCEM), Hôpital Neurologique Pierre Wertheimer, Bron; Centre des Neurosciences de Lyon-FORGETTING Team (R.M.), INSERM 1028 and CNRS UMR5292; and Université Claude Bernard Lyon 1 (R.M.), France
| | - Romain Deschamps
- From the Department of Neurology (S.D., N.C., J.D.S.); Clinical Investigation Center (N.C., J.D.S.), Strasbourg University Hospital; Department of Neurology (B.A.), APHM, Hôpital de la Timone, Pôle de Neurosciences Cliniques, Marseille; Department of Neurology (X.A.), Montpellier University Hospital; Department of Neurology (B.B.), Rouen University Hospital; Department of Neurology CRC-SEP (J.C.), CHU Toulouse; Department of Neurology, CHU Poitiers (J.C.); Department of Neurology (M.C.), CHU de Nice, UR2CA-URRIS, Nice Côte d'Azur University; Department of Neurology (R.D.), Hôpital Fondation Adolphe de Rothschild, Paris; Department of Neurology (F.D.U.R.A.N.D.-D.U.B.I.E.F.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Hôpital Neurologique, Hospices Civils de Lyon; Department of Neurology (E.M., C.P.), AP-HP, Pitié-Salpêtrière Hospital, Paris; Department of Neurology (Groupe Hospitalier Pellegrin) (A.R.), Centre Hospitalier Universitaire de Bordeaux; Université de Bordeaux (A.R.), INSERM U1215, Neurocentre Magendie; Department of Neurology (H.Z.), University Hospital of Lille, UFR3S Univ-Lille, Inserm U 1172; Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro Inflammation (R.M.), and Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (MIRCEM), Hôpital Neurologique Pierre Wertheimer, Bron; Centre des Neurosciences de Lyon-FORGETTING Team (R.M.), INSERM 1028 and CNRS UMR5292; and Université Claude Bernard Lyon 1 (R.M.), France
| | - Françoise Durand-Dubief
- From the Department of Neurology (S.D., N.C., J.D.S.); Clinical Investigation Center (N.C., J.D.S.), Strasbourg University Hospital; Department of Neurology (B.A.), APHM, Hôpital de la Timone, Pôle de Neurosciences Cliniques, Marseille; Department of Neurology (X.A.), Montpellier University Hospital; Department of Neurology (B.B.), Rouen University Hospital; Department of Neurology CRC-SEP (J.C.), CHU Toulouse; Department of Neurology, CHU Poitiers (J.C.); Department of Neurology (M.C.), CHU de Nice, UR2CA-URRIS, Nice Côte d'Azur University; Department of Neurology (R.D.), Hôpital Fondation Adolphe de Rothschild, Paris; Department of Neurology (F.D.U.R.A.N.D.-D.U.B.I.E.F.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Hôpital Neurologique, Hospices Civils de Lyon; Department of Neurology (E.M., C.P.), AP-HP, Pitié-Salpêtrière Hospital, Paris; Department of Neurology (Groupe Hospitalier Pellegrin) (A.R.), Centre Hospitalier Universitaire de Bordeaux; Université de Bordeaux (A.R.), INSERM U1215, Neurocentre Magendie; Department of Neurology (H.Z.), University Hospital of Lille, UFR3S Univ-Lille, Inserm U 1172; Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro Inflammation (R.M.), and Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (MIRCEM), Hôpital Neurologique Pierre Wertheimer, Bron; Centre des Neurosciences de Lyon-FORGETTING Team (R.M.), INSERM 1028 and CNRS UMR5292; and Université Claude Bernard Lyon 1 (R.M.), France
| | - Elisabeth Maillart
- From the Department of Neurology (S.D., N.C., J.D.S.); Clinical Investigation Center (N.C., J.D.S.), Strasbourg University Hospital; Department of Neurology (B.A.), APHM, Hôpital de la Timone, Pôle de Neurosciences Cliniques, Marseille; Department of Neurology (X.A.), Montpellier University Hospital; Department of Neurology (B.B.), Rouen University Hospital; Department of Neurology CRC-SEP (J.C.), CHU Toulouse; Department of Neurology, CHU Poitiers (J.C.); Department of Neurology (M.C.), CHU de Nice, UR2CA-URRIS, Nice Côte d'Azur University; Department of Neurology (R.D.), Hôpital Fondation Adolphe de Rothschild, Paris; Department of Neurology (F.D.U.R.A.N.D.-D.U.B.I.E.F.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Hôpital Neurologique, Hospices Civils de Lyon; Department of Neurology (E.M., C.P.), AP-HP, Pitié-Salpêtrière Hospital, Paris; Department of Neurology (Groupe Hospitalier Pellegrin) (A.R.), Centre Hospitalier Universitaire de Bordeaux; Université de Bordeaux (A.R.), INSERM U1215, Neurocentre Magendie; Department of Neurology (H.Z.), University Hospital of Lille, UFR3S Univ-Lille, Inserm U 1172; Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro Inflammation (R.M.), and Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (MIRCEM), Hôpital Neurologique Pierre Wertheimer, Bron; Centre des Neurosciences de Lyon-FORGETTING Team (R.M.), INSERM 1028 and CNRS UMR5292; and Université Claude Bernard Lyon 1 (R.M.), France
| | - Caroline Papeix
- From the Department of Neurology (S.D., N.C., J.D.S.); Clinical Investigation Center (N.C., J.D.S.), Strasbourg University Hospital; Department of Neurology (B.A.), APHM, Hôpital de la Timone, Pôle de Neurosciences Cliniques, Marseille; Department of Neurology (X.A.), Montpellier University Hospital; Department of Neurology (B.B.), Rouen University Hospital; Department of Neurology CRC-SEP (J.C.), CHU Toulouse; Department of Neurology, CHU Poitiers (J.C.); Department of Neurology (M.C.), CHU de Nice, UR2CA-URRIS, Nice Côte d'Azur University; Department of Neurology (R.D.), Hôpital Fondation Adolphe de Rothschild, Paris; Department of Neurology (F.D.U.R.A.N.D.-D.U.B.I.E.F.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Hôpital Neurologique, Hospices Civils de Lyon; Department of Neurology (E.M., C.P.), AP-HP, Pitié-Salpêtrière Hospital, Paris; Department of Neurology (Groupe Hospitalier Pellegrin) (A.R.), Centre Hospitalier Universitaire de Bordeaux; Université de Bordeaux (A.R.), INSERM U1215, Neurocentre Magendie; Department of Neurology (H.Z.), University Hospital of Lille, UFR3S Univ-Lille, Inserm U 1172; Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro Inflammation (R.M.), and Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (MIRCEM), Hôpital Neurologique Pierre Wertheimer, Bron; Centre des Neurosciences de Lyon-FORGETTING Team (R.M.), INSERM 1028 and CNRS UMR5292; and Université Claude Bernard Lyon 1 (R.M.), France
| | - Aurélie Ruet
- From the Department of Neurology (S.D., N.C., J.D.S.); Clinical Investigation Center (N.C., J.D.S.), Strasbourg University Hospital; Department of Neurology (B.A.), APHM, Hôpital de la Timone, Pôle de Neurosciences Cliniques, Marseille; Department of Neurology (X.A.), Montpellier University Hospital; Department of Neurology (B.B.), Rouen University Hospital; Department of Neurology CRC-SEP (J.C.), CHU Toulouse; Department of Neurology, CHU Poitiers (J.C.); Department of Neurology (M.C.), CHU de Nice, UR2CA-URRIS, Nice Côte d'Azur University; Department of Neurology (R.D.), Hôpital Fondation Adolphe de Rothschild, Paris; Department of Neurology (F.D.U.R.A.N.D.-D.U.B.I.E.F.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Hôpital Neurologique, Hospices Civils de Lyon; Department of Neurology (E.M., C.P.), AP-HP, Pitié-Salpêtrière Hospital, Paris; Department of Neurology (Groupe Hospitalier Pellegrin) (A.R.), Centre Hospitalier Universitaire de Bordeaux; Université de Bordeaux (A.R.), INSERM U1215, Neurocentre Magendie; Department of Neurology (H.Z.), University Hospital of Lille, UFR3S Univ-Lille, Inserm U 1172; Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro Inflammation (R.M.), and Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (MIRCEM), Hôpital Neurologique Pierre Wertheimer, Bron; Centre des Neurosciences de Lyon-FORGETTING Team (R.M.), INSERM 1028 and CNRS UMR5292; and Université Claude Bernard Lyon 1 (R.M.), France
| | - Helene Zephir
- From the Department of Neurology (S.D., N.C., J.D.S.); Clinical Investigation Center (N.C., J.D.S.), Strasbourg University Hospital; Department of Neurology (B.A.), APHM, Hôpital de la Timone, Pôle de Neurosciences Cliniques, Marseille; Department of Neurology (X.A.), Montpellier University Hospital; Department of Neurology (B.B.), Rouen University Hospital; Department of Neurology CRC-SEP (J.C.), CHU Toulouse; Department of Neurology, CHU Poitiers (J.C.); Department of Neurology (M.C.), CHU de Nice, UR2CA-URRIS, Nice Côte d'Azur University; Department of Neurology (R.D.), Hôpital Fondation Adolphe de Rothschild, Paris; Department of Neurology (F.D.U.R.A.N.D.-D.U.B.I.E.F.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Hôpital Neurologique, Hospices Civils de Lyon; Department of Neurology (E.M., C.P.), AP-HP, Pitié-Salpêtrière Hospital, Paris; Department of Neurology (Groupe Hospitalier Pellegrin) (A.R.), Centre Hospitalier Universitaire de Bordeaux; Université de Bordeaux (A.R.), INSERM U1215, Neurocentre Magendie; Department of Neurology (H.Z.), University Hospital of Lille, UFR3S Univ-Lille, Inserm U 1172; Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro Inflammation (R.M.), and Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (MIRCEM), Hôpital Neurologique Pierre Wertheimer, Bron; Centre des Neurosciences de Lyon-FORGETTING Team (R.M.), INSERM 1028 and CNRS UMR5292; and Université Claude Bernard Lyon 1 (R.M.), France
| | - Romain Marignier
- From the Department of Neurology (S.D., N.C., J.D.S.); Clinical Investigation Center (N.C., J.D.S.), Strasbourg University Hospital; Department of Neurology (B.A.), APHM, Hôpital de la Timone, Pôle de Neurosciences Cliniques, Marseille; Department of Neurology (X.A.), Montpellier University Hospital; Department of Neurology (B.B.), Rouen University Hospital; Department of Neurology CRC-SEP (J.C.), CHU Toulouse; Department of Neurology, CHU Poitiers (J.C.); Department of Neurology (M.C.), CHU de Nice, UR2CA-URRIS, Nice Côte d'Azur University; Department of Neurology (R.D.), Hôpital Fondation Adolphe de Rothschild, Paris; Department of Neurology (F.D.U.R.A.N.D.-D.U.B.I.E.F.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Hôpital Neurologique, Hospices Civils de Lyon; Department of Neurology (E.M., C.P.), AP-HP, Pitié-Salpêtrière Hospital, Paris; Department of Neurology (Groupe Hospitalier Pellegrin) (A.R.), Centre Hospitalier Universitaire de Bordeaux; Université de Bordeaux (A.R.), INSERM U1215, Neurocentre Magendie; Department of Neurology (H.Z.), University Hospital of Lille, UFR3S Univ-Lille, Inserm U 1172; Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro Inflammation (R.M.), and Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (MIRCEM), Hôpital Neurologique Pierre Wertheimer, Bron; Centre des Neurosciences de Lyon-FORGETTING Team (R.M.), INSERM 1028 and CNRS UMR5292; and Université Claude Bernard Lyon 1 (R.M.), France
| | - Jerome De Seze
- From the Department of Neurology (S.D., N.C., J.D.S.); Clinical Investigation Center (N.C., J.D.S.), Strasbourg University Hospital; Department of Neurology (B.A.), APHM, Hôpital de la Timone, Pôle de Neurosciences Cliniques, Marseille; Department of Neurology (X.A.), Montpellier University Hospital; Department of Neurology (B.B.), Rouen University Hospital; Department of Neurology CRC-SEP (J.C.), CHU Toulouse; Department of Neurology, CHU Poitiers (J.C.); Department of Neurology (M.C.), CHU de Nice, UR2CA-URRIS, Nice Côte d'Azur University; Department of Neurology (R.D.), Hôpital Fondation Adolphe de Rothschild, Paris; Department of Neurology (F.D.U.R.A.N.D.-D.U.B.I.E.F.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Hôpital Neurologique, Hospices Civils de Lyon; Department of Neurology (E.M., C.P.), AP-HP, Pitié-Salpêtrière Hospital, Paris; Department of Neurology (Groupe Hospitalier Pellegrin) (A.R.), Centre Hospitalier Universitaire de Bordeaux; Université de Bordeaux (A.R.), INSERM U1215, Neurocentre Magendie; Department of Neurology (H.Z.), University Hospital of Lille, UFR3S Univ-Lille, Inserm U 1172; Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro Inflammation (R.M.), and Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (MIRCEM), Hôpital Neurologique Pierre Wertheimer, Bron; Centre des Neurosciences de Lyon-FORGETTING Team (R.M.), INSERM 1028 and CNRS UMR5292; and Université Claude Bernard Lyon 1 (R.M.), France.
| |
Collapse
|
3
|
Gholizadeh S, Exuzides A, Lewis KE, Palmer C, Waltz M, Rose JW, Jolley AM, Behne JM, Behne MK, Blaschke TF, Smith TJ, Sinnott J, Cook LJ, Yeaman MR. Clinical and epidemiological correlates of treatment change in patients with NMOSD: insights from the CIRCLES cohort. J Neurol 2023; 270:2048-2058. [PMID: 36565348 PMCID: PMC10025181 DOI: 10.1007/s00415-022-11529-6] [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: 08/04/2022] [Revised: 12/12/2022] [Accepted: 12/13/2022] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Neuromyelitis optica spectrum disorders (NMOSD) represent rare autoimmune diseases of the central nervous system largely targeting optic nerve(s) and spinal cord. The present analysis used real-world data to identify clinical and epidemiological correlates of treatment change in patients with NMOSD. METHODS CIRCLES is a longitudinal, observational study of NMOSD conducted at 15 centers across North America. Patients with ≥ 60 days of follow-up and receiving on-study maintenance treatment were evaluated. The mean annual relapse rate (ARR) was estimated using negative binomial models; the likelihood of treatment change was estimated using Cox proportional hazards models. Relapses were included as time-varying covariates to estimate the relationship to treatment change. RESULTS Of 542 patients included, 171 (31.5%) experienced ≥ 1 relapse on the study and 133 patients (24.5%) had ≥ 1 change in the treatment regimen. Two categories of variables significantly correlated with the likelihood of treatment change: (1) relapse: any on-study relapse (hazard ratio [HR] = 2.91; p < 0.001), relapse phenotypes (HR range = 2.15-5.49; p < 0.001), and pre-study ARR > 0.75 (HR 2.28; p < 0.001); 2) disease phenotype: brain syndrome only vs transverse myelitis involvement at onset (HR 2.44; p = 0.008), disease duration < 1 vs > 5 years (HR 1.66; p = 0.028), or autoimmune comorbidity (HR 1.55; p = 0.015). A subset of these factors significantly correlated with shorter time to first rituximab discontinuation. CONCLUSIONS In CIRCLES, relapse patterns and disease phenotype significantly correlated with changes in the maintenance treatment regimen. Such findings may facilitate the identification of patients with NMOSD who are likely to benefit from treatment change to reduce relapse risk or disease burden and enhance the quality of life.
Collapse
Affiliation(s)
| | | | - Katelyn E Lewis
- University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Chella Palmer
- University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Michael Waltz
- University of Utah School of Medicine, Salt Lake City, UT, USA
| | - John W Rose
- University of Utah School of Medicine, Salt Lake City, UT, USA
| | | | - Jacinta M Behne
- The Guthy-Jackson Charitable Foundation, Beverly Hills, CA, USA
| | - Megan K Behne
- The Guthy-Jackson Charitable Foundation, Beverly Hills, CA, USA
| | - Terrence F Blaschke
- Departments of Medicine and of Molecular Pharmacology, Stanford University School of Medicine, Stanford, CA, USA
| | - Terry J Smith
- University of Michigan Kellogg Eye Center, Ann Arbor, MI, USA
| | - Jennifer Sinnott
- University of Utah School of Medicine, Salt Lake City, UT, USA
- Department of Statistics, The Ohio State University, Columbus, OH, USA
| | - Lawrence J Cook
- University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Michael R Yeaman
- Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
- Division of Molecular Medicine, David Geffen School of Medicine at UCLA, Institute for Infection and Immunity, Harbor-UCLA Medical Center, Lundquist Institute at Harbor-UCLA Medical Center, 1124 West Carson Street, Torrance, CA, 90502, USA.
| | | |
Collapse
|
4
|
Dong GY, Meng YH, Xiao XJ. A meta-analysis on efficacy and safety of rituximab for neuromyelitis optica spectrum disorders. Medicine (Baltimore) 2022; 101:e30347. [PMID: 36086713 PMCID: PMC10980488 DOI: 10.1097/md.0000000000030347] [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: 11/18/2021] [Accepted: 06/24/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND To assess the efficacy and safety of rituximab (RTX) in the treatment of neuromyelitis optica spectrum diseases (NMOSDs), and give a guideline on clinical medication. METHODS The databases of Pubmed, Embase, Cochrane Library, CNKI, and Wan fang were systematically searched by computer, and the search period was from the establishment of the databases until January 2022. To collect the trials of RTX in the treatment of NMOSDs, two researchers completed literature screening, quality assessment, and data extraction independently. Statistical analysis was performed using Review Manager 5.3 and Stata 15.1 software. RESULTS There were 37 studies in the meta-analysis, including 5 randomized controlled trials (RCTs) and 32 observational studies. Meta-analysis results revealed that NMOSDs patients treated with RTX significantly reduced the annualized relapse rate (ARR) (weighted mean difference [WMD] = 1.45, 95% confidence interval [CI]: 1.24-1.66, P < .01) and the Expanded disability status scale (EDSS) scores (WMD = 1.34, 95%CI: 1.25-1.44, P < .01). RTX is more effective than azathioprine (AZA) in the treatment of NMOSDs (ARR: WMD = -0.54, 95% CI: -0.75 to -0.33; EDSS: WMD = -0.65, 95% CI: -0.83 to -0.48; P < .0001).There was no difference in ARR and EDSS scores between anti-aquapor in-4-antibody seropositive NMOSD and seronegative NMOSD patients treated with RTX (ARR: WMD = -0.01, 95% CI: -0.25 to 0.24, P = .96 > 0.05; EDSS: WMD = 0, 95% CI: -0.30 to 0.31, P = .99 > 0.05). In this study, 681 patients were recorded safety data of RTX therapy, 23% (156 patients) had adverse events, and 0.7% (5 patients) of NMOSDs discontinued due to severe adverse reactions. CONCLUSIONS NMOSDs patients treated with RTX can significantly reduce the relapse frequency and EDSS scores, and also improve neurological dysfunction, besides the efficacy is better than azathioprine. RTX has a high incidence of adverse reactions, which are mild and with certain self limited, it should be cautious in clinical medication.
Collapse
Affiliation(s)
- Gu-Yi Dong
- Department of Neurology, Hebei General Hospital, Shijiazhuang, China
| | - Yan-Hong Meng
- Department of Neurology, Kailuan General Hospital, Tangshan, China
| | - Xiang-Jian Xiao
- Department of Neurology, Hebei General Hospital, Shijiazhuang, China
| |
Collapse
|
5
|
Lin J, Xue B, Li J, Zhu R, Pan J, Chen Z, Zhang X, Li X, Xia J. Comparison of Long-Term Use of Low Dose Rituximab and Mycophenolate Mofetil in Chinese Patients With Neuromyelitis Optica Spectrum Disorder. Front Neurol 2022; 13:891064. [PMID: 35599732 PMCID: PMC9120916 DOI: 10.3389/fneur.2022.891064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 04/15/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundSeveral studies have reported the efficacy and safety of rituximab (RTX) and mycophenolate mofetil (MMF) in neuromyelitis optica spectrum disorder (NMOSD). This study aimed to evaluate the efficacy and safety of long-term use of low-dose RTX and MMF in Chinese patients with NMOSD.MethodsWe retrospectively reviewed data from patients with NMOSD in our hospital. The enrolled patients were administrated different immunosuppressive agents. We accessed annual relapse rate (ARR), neurological disability (Expanded Disability Status Scale, EDSS), time to the next relapse, and adverse events.ResultsEDSS and ARR were both reduced after RTX and MMF treatment. Kaplan-Meier analysis indicated that patients treated with RTX had a longer time to next relapse compared other immunosuppressive agents before RTX (log-rank test: p < 0.001). Furthermore, we evaluated the change of EDSS and ARR in RTX and MMF, and patients treated with RTX showed a better reduction. Eleven relapses from seven patients in group RTX and 20 relapses from 14 patients in group MMF were reported during follow-up.ConclusionLong-term using of low dose of RTX and MMF were effective and tolerable in Chinese patients with NMOSD. Compared with MMF, RTX showed a better way to reduce the ARR.
Collapse
Affiliation(s)
- Jie Lin
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Binbin Xue
- Department of Anesthesiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jia Li
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Ruofan Zhu
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Juyuan Pan
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Zhibo Chen
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xu Zhang
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiang Li
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- *Correspondence: Xiang Li
| | - Junhui Xia
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- Junhui Xia
| |
Collapse
|
6
|
Abbadessa G, Miele G, Maida E, Minervini G, Lavorgna L, Bonavita S. Optimal retreatment schedule of rituximab for neuromyelitis optica spectrum disorder: a systematic review. Mult Scler Relat Disord 2022; 63:103926. [DOI: 10.1016/j.msard.2022.103926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 05/14/2022] [Accepted: 05/27/2022] [Indexed: 10/18/2022]
|
7
|
Experience with tocilizumab in patients with neuromyelitis optica spectrum disorders. NEUROLOGÍA (ENGLISH EDITION) 2022; 37:178-183. [PMID: 35465911 DOI: 10.1016/j.nrleng.2018.12.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 12/22/2018] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Neuromyelitis optica spectrum disorders (NMOSD) are immune-mediated inflammatory disorders of the central nervous system involving astrocytes, B lymphocytes, anti-aquaporin 4, and such inflammatory mediators as interleukin-6. Several immunosuppressants are used in their treatment. Tocilizumab, an interleukin-6 receptor antagonist, may be a treatment option. METHOD We performed an observational, retrospective study analysing parameters of effectiveness (annualised relapse rate, disability, and radiological progression) and safety of tocilizumab in patients with NMOSD in whom previous immunosuppressant treatment had failed. We aimed to evaluate the effectiveness and safety of tocilizumab in clinical practice in patients with NMOSD not responding to other immunosuppressants. RESULTS Five patients with NMOSD were analysed. Sixty percent of patients were women; mean age at diagnosis was 50±5.3 years and mean progression time was 4.5±3.6 years. Previously administered immunosuppressants were rituximab (in all 5), cyclophosphamide (2), and azathioprine (1). Mean time of exposure to tocilizumab was 2.3±1 years. Mean annualised relapse rate was 1.8±1.3 in the year prior to the introduction of tocilizumab and 0.2±0.4 the year after (P<.05), representing a reduction of 88.9%. CONCLUSIONS In our experience, tocilizumab is safe and effective in patients with NMOSD showing no response to other immunosuppressants.
Collapse
|
8
|
Carreón Guarnizo E, Hernández Clares R, Castillo Triviño T, Meca Lallana V, Arocas Casañ V, Iniesta Martínez F, Olascoaga Urtaza J, Meca Lallana JE. Experience with tocilizumab in patients with neuromyelitis optica spectrum disorders. Neurologia 2022; 37:178-183. [PMID: 30928236 DOI: 10.1016/j.nrl.2018.12.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 08/28/2018] [Accepted: 12/22/2018] [Indexed: 10/27/2022] Open
Abstract
INTRODUCTION Neuromyelitis optica spectrum disorders (NMOSD) are immune-mediated inflammatory disorders of the central nervous system involving astrocytes, B lymphocytes, anti-aquaporin 4, and such inflammatory mediators as interleukin-6. Several immunosuppressants are used in their treatment. Tocilizumab, an interleukin-6 receptor antagonist, may be a treatment option. METHOD We performed an observational, retrospective study analysing parameters of effectiveness (annualised relapse rate, disability, and radiological progression) and safety of tocilizumab in patients with NMOSD in whom previous immunosuppressant treatment had failed. We aimed to evaluate the effectiveness and safety of tocilizumab in clinical practice in patients with NMOSD not responding to other immunosuppressants. RESULTS Five patients with NMOSD were analysed. Sixty percent of patients were women; mean age at diagnosis was 50±5.3 years and mean progression time was 4.5±3.6 years. Previously administered immunosuppressants were rituximab (in all 5), cyclophosphamide (2), and azathioprine (1). Mean time of exposure to tocilizumab was 2.3±1 years. Mean annualised relapse rate was 1.8±1.3 in the year prior to the introduction of tocilizumab and 0.2±0.4 the year after (P <.05), representing a reduction of 88.9%. CONCLUSIONS In our experience, tocilizumab is safe and effective in patients with NMOSD showing no response to other immunosuppressants.
Collapse
Affiliation(s)
- E Carreón Guarnizo
- CSUR Esclerosis Múltiple y Unidad de Neuroinmunología Clínica, Servicio de Neurología, Hospital Clínico Universitario Virgen de la Arrixaca, IMIB-Arrixaca, Murcia, España; Cátedra de Neuroinmunología Clínica y Esclerosis Múltiple, UCAM, Universidad Católica San Antonio, Murcia, España.
| | - R Hernández Clares
- CSUR Esclerosis Múltiple y Unidad de Neuroinmunología Clínica, Servicio de Neurología, Hospital Clínico Universitario Virgen de la Arrixaca, IMIB-Arrixaca, Murcia, España; Cátedra de Neuroinmunología Clínica y Esclerosis Múltiple, UCAM, Universidad Católica San Antonio, Murcia, España
| | - T Castillo Triviño
- Unidad de Esclerosis Múltiple, Servicio de Neurología, Hospital Universitario Donostia, San Sebastián, España
| | - V Meca Lallana
- Unidad de Esclerosis Múltiple, Servicio de Neurología, Hospital Universitario de La Princesa, Madrid, España
| | - V Arocas Casañ
- Servicio de Farmacia, Hospital Clínico Universitario Virgen de la Arrixaca, IMIB-Arrixaca, Murcia, España
| | - F Iniesta Martínez
- Cátedra de Neuroinmunología Clínica y Esclerosis Múltiple, UCAM, Universidad Católica San Antonio, Murcia, España
| | - J Olascoaga Urtaza
- Unidad de Esclerosis Múltiple, Servicio de Neurología, Hospital Universitario Donostia, San Sebastián, España
| | - J E Meca Lallana
- CSUR Esclerosis Múltiple y Unidad de Neuroinmunología Clínica, Servicio de Neurología, Hospital Clínico Universitario Virgen de la Arrixaca, IMIB-Arrixaca, Murcia, España; Cátedra de Neuroinmunología Clínica y Esclerosis Múltiple, UCAM, Universidad Católica San Antonio, Murcia, España
| |
Collapse
|
9
|
Foo R, Yau C, Singhal S, Tow S, Loo JL, Tan K, Milea D. Optic Neuritis in the Era of NMOSD and MOGAD: A Survey of Practice Patterns in Singapore. Asia Pac J Ophthalmol (Phila) 2022; 11:184-195. [PMID: 35533337 DOI: 10.1097/apo.0000000000000513] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
PURPOSE The Optic Neuritis Treatment Trial was a landmark study with implications worldwide. In the advent of antibody testing for neuromyelitis optica spectrum disease (NMOSD) and myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD), emerging concepts, such as routine antibody testing and management, remain controversial, resulting mostly from studies in White populations. We evaluate the practice patterns of optic neuritis investigation and management by neuro-ophthalmologists and neurologists in Singapore. DESIGN 21-question online survey consisting of 4 clinical vignettes. METHODS The survey was sent to all Singapore Medical Council- registered ophthalmologists and neurologists who regularly manage patients with optic neuritis. RESULTS Forty-two recipients (17 formally trained neuro-ophthalmol-ogists [100% response rate] and 25 neurologists) responded. Participants opted for routine testing of anti-aquaporin-4 antibodies (88.1% in mild optic neuritis and 97.6% in severe optic neuritis). Anti-MOG antibodies were frequently obtained (76.2% in mild and 88.1% in severe optic neuritis). Plasmapheresis was rapidly initiated (85.7%) in cases of nonresponse to intravenous steroids, even before obtaining anti-aquaporin-4 or anti-MOG serology results. In both NMOSD and MOGAD, oral mycophenolate mofetil was the preferred option if chronic immunosuppression was necessary. Steroids were given for a longer duration and tapered more gradually than in idiopathic optic neuritis cases. CONCLUSIONS Serological testing for NMOSD and MOGAD is considered as a routine procedure in cases of optic neuritis in Singapore, possibly due to local epidemiological features of these conditions. Chronic oral immunosuppression is preferred for the long term, but further research is necessary to establish the efficacy and cost-effectiveness of these practices.
Collapse
Affiliation(s)
- Reuben Foo
- Department of Neuro-Ophthalmology, Singapore National Eye Centre, Singapore City, Singapore
| | - Christine Yau
- Department of Neuro-Ophthalmology, Singapore National Eye Centre, Singapore City, Singapore
| | - Shweta Singhal
- Department of Neuro-Ophthalmology, Singapore National Eye Centre, Singapore City, Singapore
- Singapore Eye Research Institute, Singapore City, Singapore
- Duke-NUS Medical School, Singapore City, Singapore
| | - Sharon Tow
- Department of Neuro-Ophthalmology, Singapore National Eye Centre, Singapore City, Singapore
- Duke-NUS Medical School, Singapore City, Singapore
| | - Jing-Liang Loo
- Department of Neuro-Ophthalmology, Singapore National Eye Centre, Singapore City, Singapore
- Singapore Eye Research Institute, Singapore City, Singapore
- National University Hospital, Singapore City, Singapore
| | - Kevin Tan
- Duke-NUS Medical School, Singapore City, Singapore
- Department of Neurology, National Neuroscience Institute, Singapore City, Singapore
| | - Dan Milea
- Department of Neuro-Ophthalmology, Singapore National Eye Centre, Singapore City, Singapore
- Singapore Eye Research Institute, Singapore City, Singapore
- Duke-NUS Medical School, Singapore City, Singapore
| |
Collapse
|
10
|
Ma J, Yu H, Wang H, Zhang X, Feng K. Evaluation of effect of empirical attack-preventive immunotherapies in neuromyelitis optica spectrum disorders: An update systematic review and meta -analysis. J Neuroimmunol 2021; 363:577790. [PMID: 34959021 DOI: 10.1016/j.jneuroim.2021.577790] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 11/28/2021] [Accepted: 12/11/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Neuromyelitis optica spectrum disorder (NMOSD) is an inflammatory disease of the central nervous system, which mainly involves the optic nerve and spinal cord. Frequent relapse can accumulate the degree of disability. At present, the main treatment options are immunosuppressants and blood purification. The first-line immunosuppressants for NMOSD are mainly rituximab (RTX), mycophenolate mofetil (MMF) and azathioprine (AZA). Therefore, we designed this systematic review and meta-analysis to evaluate the safety and effect of the above three drugs in the treatment of NMOSD patients. METHODS The following Medical Subject Heading (MeSH) and related entry terms are used to search English literature in PubMed, MEDLINE and CENTRAL databases, respectively. MeSH include: Neuromyelitis optic and Rituximab or Azathioprine or Mycophenolate Mofetil; entry terms include: NMO Spectrum Disorder, NMO Spectrum Disorders, Neuromyelitis Optica (NMO) Spectrum Disorder, Neuromyelitis Optica Spectrum Disorders, Devic Neuromyelitis Optica, Neuromyelitis Optica, Devic, Devic's Disease, Devic Syndrome, Devic's Neuromyelitis Optica, Neuromyelitis Optica (NMO) Spectrum Disorders, CD20 Antibody, Rituximab CD20 Antibody, Mabthera, IDEC-C2B8 Antibody, GP2013, Rituxan, Mycophenolate Mofetil, Mofetil, Mycophenolate, Mycophenolic Acid, Morpholinoethyl Ester, Cellcept, Mycophenolate Sodium, Myfortic, Mycophenolate Mofetil Hydrochloride, Mofetil Hydrochloride, Mycophenolate, RS 61443, RS-61443, RS61443, azathioprine sodium, azathioprine sulfate (note: literature retrieval operators "AND" "OR" "NOT" are used to link MeSH with Entry Terms.) The literature search found a total of 3058 articles about rituximab, mycophenolate mofetil and azathioprine in the treatment of NMOSD, 63 of which were included in this study after a series of screening. RESULTS 930,933,732 patients with NMOSD were enrolled, who had been treated with MMF, AZA and RTX, respectively. The pooled standardized mean difference (SMD) of EDSS before and after RTX treated was -0.58 (95%CI: -0.72, -0.44) (I2 = 0%, p = 0.477), before and after MMF treated was -0.47 (95%CI: -0.73, -0.21) (I2 = 85.6%, p<0.001), before and after AZA treated was -0.41 (95%CI: -0.60, -0.23) (I2 = 65.4%, p<0.001). there was no significant difference in the effect of the three drugs on reducing EDSS scores (RTX vs MMF, p = 0.522; RTX vs AZA, p = 0.214; MMF vs AZA, p = 0.732). The pooled standardized mean difference (SMD) of ARR before and after RTX treated was -1.45 (95%CI: -1.72, -1.18) (I2 = 72.4%, p<0.001), before and after MMF treated was -1.14 (95%CI: -1.31, -0.97) (I2 = 54.5%, p<0.001), before and after AZA treated was -1.11 (95%CI: -1.39, -0.83) (I2 = 83.4%, p<0.001). RTX significantly reduced ARR compared with the other two drugs (RTX vs MMF, p = 0.039; RTX vs AZA, p = 0.049; MMF vs AZA, p = 0.436). CONCLUSION The results of this systematic review and meta-analysis showed that the treatment of NMOSD patients with RTX, MMF and AZA is associated with decreased number of relapses and disability improvement as well, and there was no significant difference in the effect of the three drugs on reducing EDSS scores, but RTX significantly reduced ARR compared with the other two drugs.
Collapse
Affiliation(s)
- Jia Ma
- Department of Neurology, Beijing Shunyi Hospital, NO.3 Guangming South Street, Shunyi District, Beijing 101300, China; Department of Neurology, Beijing Tiantan Hospital, China National Clinical Research Center for Neurological Diseases, Capital Medical University, No.119 South 4th Ring West Road, Fengtai District, Beijing 100160, China
| | - Haihua Yu
- Department of Neurology, Beijing Shunyi Hospital, NO.3 Guangming South Street, Shunyi District, Beijing 101300, China
| | - Hao Wang
- Department of Neurology, Beijing Shunyi Hospital, NO.3 Guangming South Street, Shunyi District, Beijing 101300, China
| | - Xinghu Zhang
- Department of Neurology, Beijing Tiantan Hospital, China National Clinical Research Center for Neurological Diseases, Capital Medical University, No.119 South 4th Ring West Road, Fengtai District, Beijing 100160, China.
| | - Kai Feng
- Department of Neurology, Beijing Shunyi Hospital, NO.3 Guangming South Street, Shunyi District, Beijing 101300, China.
| |
Collapse
|
11
|
Sawaya R, Saab G, Moussa H. Should tocilizumab be the first line treatment for neuromyelitis optica together with rituximab? NEUROLOGÍA (ENGLISH EDITION) 2021; 36:642-643. [PMID: 34654538 DOI: 10.1016/j.nrleng.2020.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 10/10/2020] [Indexed: 11/27/2022] Open
Affiliation(s)
- R Sawaya
- Department of Neurology, American University of Beirut Medical Center, Beirut, Lebanon.
| | - G Saab
- Department of Neurology, American University of Beirut Medical Center, Beirut, Lebanon
| | - H Moussa
- Department of Neurology, American University of Beirut Medical Center, Beirut, Lebanon
| |
Collapse
|
12
|
Treatment of Neuromyelitis Optica Spectrum Disorders. Int J Mol Sci 2021; 22:ijms22168638. [PMID: 34445343 PMCID: PMC8395403 DOI: 10.3390/ijms22168638] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 07/29/2021] [Accepted: 07/31/2021] [Indexed: 12/11/2022] Open
Abstract
Neuromyelitis optica spectrum disorder (NMOSD) is an autoimmune central nervous system (CNS) inflammatory disorder that can lead to serious disability and mortality. Females are predominantly affected, including those within the reproductive age. Most patients develop relapsing attacks of optic neuritis; longitudinally extensive transverse myelitis; and encephalitis, especially brainstem encephalitis. The majority of NMOSD patients are seropositive for IgG autoantibodies against the water channel protein aquaporin-4 (AQP4-IgG), reflecting underlying aquaporin-4 autoimmunity. Histological findings of the affected CNS tissues of patients from in-vitro and in-vivo studies support that AQP4-IgG is directly pathogenic in NMOSD. It is believed that the binding of AQP4-IgG to CNS aquaporin-4 (abundantly expressed at the endfoot processes of astrocytes) triggers astrocytopathy and neuroinflammation, resulting in acute attacks. These attacks of neuroinflammation can lead to pathologies, including aquaporin-4 loss, astrocytic activation, injury and loss, glutamate excitotoxicity, microglial activation, neuroinflammation, demyelination, and neuronal injury, via both complement-dependent and complement-independent pathophysiological mechanisms. With the increased understanding of these mechanisms underlying this serious autoimmune astrocytopathy, effective treatments for both active attacks and long-term immunosuppression to prevent relapses in NMOSD are increasingly available based on the evidence from retrospective observational data and prospective clinical trials. Knowledge on the indications and potential side effects of these medications are essential for a clear evaluation of the potential benefits and risks to NMOSD patients in a personalized manner. Special issues such as pregnancy and the coexistence of other autoimmune diseases require additional concern and meticulous care. Future directions include the identification of clinically useful biomarkers for the prediction of relapse and monitoring of the therapeutic response, as well as the development of effective medications with minimal side effects, especially opportunistic infections complicated by long-term immunosuppression.
Collapse
|
13
|
Uzunköprü C, Tütüncü M, Gündüz T, Gümüş H, Şen S, Demir S, Çınar BP, Türe HS, Uygunoğlu U, Toğrol RE, Terzi M, Kürtüncü M, Özakbaş S, Tütüncü M, Beckmann Y, Siva A. The efficacy of rituximab in patients with neuromyelitis optica spectrum disorder: A real-world study from Turkey. Int J Clin Pract 2021; 75:e14158. [PMID: 33743552 DOI: 10.1111/ijcp.14158] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 03/17/2021] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Neuromyelitis optica spectrum disorders (NMOSD) are a group of antibody-mediated chronic inflammatory diseases of the central nervous system. Rituximab is a monoclonal antibody that leads to a reduction in disease activity. OBJECTIVE To evaluate the efficacy of rituximab as monotherapy in NMOSD and to determine whether the efficacy varies depending on the presence of antibodies in this cohort. METHOD This multicentre national retrospective study included patients with NMOSD treated with rituximab at least for 12 months from Turkey. The primary outcomes were the change in the annualised relapse rate, the Expanded Disability Status Scale (EDSS), the number of relapse and radiological activity-free patients. RESULTS A total of 85 patients with NMOSD were included in the study. Of 85 patients, 58 (68.2%) were seropositive for anti-Aquaporin4-IgG (antI-AQP4-IgG). All patients were Anti-Myelin Oligodendrocyte Glycoprotein IgG (anti-MOG-IgG) negative. The median follow-up for rituximab treatment was 21 months (Q1 16-Q3 34.5). During rituximab treatment, the mean annualised relapse rate (ARR) significantly decreased from 1.45 ± 1.53 to 0.15 ± 0.34 (P < .001). In subgroup analyses, the mean ARR decreased from 1.61 ± 1.65 to 0.20 ± 0.39 in the seropositive group and 1.10 ± 1.19 to 0.05 ± 0.13 in the seronegative group. The mean EDSS improved from 3.98 ± 2.04 (prior to treatment onset) to 2.71 ± 1.59 (at follow-up) (P < .001). In the seropositive group, mean EDSS decreased from 3.94 ± 1.98 to 2.67 ± 1.54, and in the seronegative group, mean EDSS decreased from 4.07 ± 2.21 to 2.79 ± 1.73. There was no significant difference between anti-AQP4-IgG (+) and (-) groups in terms of ARR and EDSS. Sixty-four patients (75.2%) were relapse-free after the initiation of treatment. Seventy patients (82.3%) were radiological activity-free in the optic nerve, area postrema and brainstem. Additionally, 78 patients (91.7%) showed no spinal cord involvement after the treatment. CONCLUSION Rituximab therapy is efficacious in the treatment of Turkish NMOSD patients independent of the presence of the anti-AQP4-IgG antibody.
Collapse
Affiliation(s)
- Cihat Uzunköprü
- Department of Neurology, Faculty of Medicine, İzmir Katip Çelebi University, Izmir, Turkey
| | - Melih Tütüncü
- Department of Neurology, Cerrahpaşa School of Medicine, Istanbul University, Istanbul, Turkey
| | - Tuncay Gündüz
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Haluk Gümüş
- Department of Neurology, Faculty of Medicine, Konya Selçuk University, Konya, Turkey
| | - Sedat Şen
- Department of Neurology, Faculty of Medicine, Samsun 19 Mayıs University, Samsun, Turkey
| | - Serkan Demir
- Department of Neurology, Sancaktepe Şehit Prof. Dr. İlhan Varank Training and Research Hospital, Istanbul, Turkey
| | - Bilge Piri Çınar
- Department of Neurology, Faculty of Medicine, Bülent Ecevit University, Zonguldak, Turkey
| | - Hatice Sabiha Türe
- Department of Neurology, Faculty of Medicine, İzmir Katip Çelebi University, Izmir, Turkey
| | - Uğur Uygunoğlu
- Department of Neurology, Cerrahpaşa School of Medicine, Istanbul University, Istanbul, Turkey
| | - Rıfat Erdem Toğrol
- Department of Neurology, Sultan Abdülhamid Han Training and Research Hospital, Istanbul, Turkey
| | - Murat Terzi
- Department of Neurology, Faculty of Medicine, Samsun 19 Mayıs University, Samsun, Turkey
| | - Murat Kürtüncü
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Serkan Özakbaş
- Department of Neurology, Faculty of Medicine, 9 Eylül University, Izmir, Turkey
| | - Mesude Tütüncü
- Department of Neurology, Prof Dr Mazhar Osman Mental Health and Neurology Training and Research Hospital, Istanbul, Turkey
| | - Yeşim Beckmann
- Department of Neurology, Faculty of Medicine, İzmir Katip Çelebi University, Izmir, Turkey
| | - Aksel Siva
- Department of Neurology, Cerrahpaşa School of Medicine, Istanbul University, Istanbul, Turkey
| |
Collapse
|
14
|
Efficacy of rituximab in the treatment of neuromyelitis optica spectrum disorders: An update systematic review and meta -analysis. Mult Scler Relat Disord 2021; 50:102843. [PMID: 33609924 DOI: 10.1016/j.msard.2021.102843] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 01/17/2021] [Accepted: 02/10/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Neuromyelitis optica spectrum disorders (NMOSD) is an autoimmune astrocyte disease that mainly affects the optic nerve and spinal cord resulting in blindness or paralysis. Rituximab (RTX) is a chimeric monoclonal antibody directed against the surface antigen of CD20 on B lymphocytes and is an emerging treatment option in NMOSD. The present review aimed to conduct an update systematic review and meta-analysis for the efficacy of RTX in the treatment of NMOSD and analyze main factors affecting the efficacy of RTX. METHODS The following Medical Subject Heading (MeSH) and related entry terms are used to search English literature in PubMed, MEDLINE and CENTRAL databases, respectively. MeSH include: Neuromyelitis optic and Rituximab; entry terms include: NMO Spectrum Disorder, NMO Spectrum Disorders, Neuromyelitis Optica (NMO) Spectrum Disorder, Neuromyelitis Optica Spectrum Disorders, Devic Neuromyelitis Optica, Neuromyelitis Optica, Devic, Devic's Disease, Devic Syndrome, Devic's Neuromyelitis Optica, Neuromyelitis Optica (NMO) Spectrum Disorders, CD20 Antibody, Rituximab CD20 Antibody, Mabthera, IDEC-C2B8 Antibody, GP2013, Rituxan; (note: literature retrieval operators "AND" "OR" "NOT" are used to link MeSH with Entry Terms.) 54 studies were included in this systematic review and 29 studies were included in meta-analysis. The main efficacy indicators were the difference of the expanded disability status scale (EDSS) and annualized relapse rate (ARR) between before and after rituximab treatments. RESULTS In 29 studies involving 732 patients (643 women, 84 men, 5 with unknown gender), the EDSS and ARR were reduced by an average of -0.57 (95%CI, -0.69 to -0.44), -1.57 (95%CI, -1.78 to -1.35), respectively. CONCLUSION Our systematic review and update meta-analysis provide new evidences that RTX can effectively improve disability and reduce ARR ratio.
Collapse
|
15
|
Xue T, Yu J, Chen S, Wang Z, Yang Y, Chen Z, Wang Z. Different Targets of Monoclonal Antibodies in Neuromyelitis Optica Spectrum Disorders: A Meta-Analysis Evidenced From Randomized Controlled Trials. Front Neurol 2020; 11:604445. [PMID: 33391166 PMCID: PMC7773932 DOI: 10.3389/fneur.2020.604445] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 11/24/2020] [Indexed: 11/29/2022] Open
Abstract
Background: Neuromyelitis optica spectrum disorder (NMOSD), an autoimmune inflammatory disorder of the central nervous system, often leads to vision loss or paralysis. This meta-analysis focused on the assessment of the monoclonal antibody therapy in NMOSD and compared different targets of monoclonal antibodies with each other in terms of efficacy and safety outcomes. Method: We searched through the databases of MEDLINE, EMBASE, Central Register of Controlled Trials (CENTRAL), and clinicaltrials.gov for randomized controlled trials (RCTs) evaluating monoclonal antibody therapy in NMOSD up to April 2020. Results: We identified seven randomized controlled trials (RCTs), including 775 patients (monoclonal antibody group, n = 485 and placebo group, n = 290). Monoclonal antibody therapy decreased relapse risk (RR 0.33, 95% CI 0.21–0.52, P < 0.00001), annualized relapse rate (ARR) (mean −0.28, 95% CI −0.35−0.20, P < 0.00001), expanded disability status scale score (EDSS) (mean −0.19, 95% CI −0.32−0.07, P = 0.002) and serious adverse events (RR 0.78, 95% CI 0.61–1.00, P = 0.05). However, we did not observe any significant difference in terms of adverse events or mortality. Further, the subgroup analysis demonstrated that the anti-complement protein C5 monoclonal antibody (eculizumab) might have a lower relapse risk (RR 0.07, 95% CI 0.02–0.23, P < 0.0001) in the AQP4 seropositive patients, and anti-interleukin-6 receptor monoclonal antibodies (satralizumab and tocilizumab) showed decreased EDSS score (mean −0.17, 95% CI −0.31−0.02, P = 0.02) more effectively than other monoclonal antibodies. Conclusions: Monoclonal antibodies were effective and safe in NMOSD. Different targets of monoclonal antibodies might have their own advantages.
Collapse
Affiliation(s)
- Tao Xue
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Jiahao Yu
- Department of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Shujun Chen
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Zilan Wang
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yanbo Yang
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Zhouqing Chen
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Zhong Wang
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, China
| |
Collapse
|
16
|
Algahtani H, Shirah B, Ibrahim B, Malik YA, Makkawi S. Clinical and Radiological Characteristics of Neuromyelitis Optica Spectrum Disorder: The Experience from Saudi Arabia. Mult Scler Relat Disord 2020; 47:102668. [PMID: 33307475 DOI: 10.1016/j.msard.2020.102668] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 11/24/2020] [Accepted: 11/28/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND Neuromyelitis optica spectrum disorder (NMOSD) is a rare autoimmune astrocytopathy that affects several regions of the central nervous system (CNS) with a predilection for the optic nerves and spinal cord. Epidemiological studies of NMOSD are uncommon in the Middle East and up-to-date, there are no such data from Saudi Arabia. In this study, we aim to study the clinical pattern of NMOSD patients in Saudi Arabia. METHODS A retrospective multi-center observational study was conducted at King Abdulaziz Medical City in Jeddah and Riyadh, Saudi Arabia. The inclusion criteria consisted of all the patients with either neuromyelitis optica according to the 2006 criteria or NMOSD according to the 2015 criteria. The study period was 20 years. RESULTS A total of 23 patients were included in the study. Four were males (17.4%) and 19 were females (82.6%). The attack type was optic neuritis in 3 patients (13.0%), transverse myelitis in 15 patients (65.2%), and both in 5 patients (21.7%). All patients (100%) received pulse steroid therapy (intravenous methylprednisolone 1 g for 5 days) at the onset of the disease. Fifteen patients had plasma exchange therapy (65.2%). All patients received maintenance immunosuppressive treatment except 1 (4.3%). CONCLUSION NMOSD is a rare, broad-spectrum, polyphasic, rare disorder primarily affecting the optic pathway and the spinal cord either in isolation or simultaneously. Unfortunately, there are no adequate studies that assess NMOSD cohorts in Saudi Arabia despite the increased number of diagnosed cases. In addition, there is no registry for this disorder with only a few specialized centers dealing with its management. It is time to establish specialized demyelinating disease centers and build expertise in both common and rare diseases in this category.
Collapse
Affiliation(s)
- Hussein Algahtani
- King Abdulaziz Medical City/ King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.
| | - Bader Shirah
- King Abdullah International Medical Research Center / King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Badr Ibrahim
- King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Yaser Al Malik
- King Saud bin Abdulaziz University for Health Sciences / King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Seraj Makkawi
- King Abdulaziz Medical City/ King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| |
Collapse
|
17
|
Sawaya R, Saab G, Moussa H. Should tocilizumab be the first line treatment for neuromyelitis optica together with rituximab? Neurologia 2020; 36:S0213-4853(20)30310-8. [PMID: 33176917 DOI: 10.1016/j.nrl.2020.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 10/10/2020] [Indexed: 11/20/2022] Open
Affiliation(s)
- R Sawaya
- Department of Neurology, American University of Beirut Medical Center, Beirut, Lebanon.
| | - G Saab
- Department of Neurology, American University of Beirut Medical Center, Beirut, Lebanon
| | - H Moussa
- Department of Neurology, American University of Beirut Medical Center, Beirut, Lebanon
| |
Collapse
|
18
|
Wallach AI, Tremblay M, Kister I. Advances in the Treatment of Neuromyelitis Optica Spectrum Disorder. Neurol Clin 2020; 39:35-49. [PMID: 33223088 DOI: 10.1016/j.ncl.2020.09.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Neuromyelitis optica spectrum disorder (NMOSD) is a rare, relapsing-remitting neuroinflammatory disorder of the central nervous system. Advances in the understanding of NMOSD pathogenesis and identification of the NMO-specific pathogenic anti-AQP4 autoantibody have led to the development of highly effective disease-modifying strategies. Five placebo-controlled, randomized trials for NMOSD have been successfully completed as of 2020. These trials support the efficacy of rituximab and tocilizumab and led to the FDA approval of eculizumab, satralizumab and inebilizumab for NMOSD. Our review provides an update on these evidence-based disease-modifying therapies and discussed the treatment of acute relapses in NMOSD.
Collapse
Affiliation(s)
- Asya Izraelit Wallach
- Alfiero and Lucia Palestroni MS Comprehensive Care Center, Holy Name Medical Center, 718 Teaneck Road, Teaneck, NJ 07666, USA.
| | - Matthew Tremblay
- MS Comprehensive Care Center, RWJ Barnabas Health, 200 South Orange Avenue, Suite 124-A, Livingston, NJ 07039, USA
| | - Ilya Kister
- Department of Neurology, Comprehensive MS Center, NYU Grossman School of Medicine, 240 East 38th Street, New York, NY 10016, USA
| |
Collapse
|
19
|
Carnero Contentti E, Rojas JI, Cristiano E, Marques VD, Flores-Rivera J, Lana-Peixoto M, Navas C, Papais-Alvarenga R, Sato DK, Soto de Castillo I, Correale J. Latin American consensus recommendations for management and treatment of neuromyelitis optica spectrum disorders in clinical practice. Mult Scler Relat Disord 2020; 45:102428. [DOI: 10.1016/j.msard.2020.102428] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 07/24/2020] [Accepted: 07/27/2020] [Indexed: 02/06/2023]
|
20
|
Xue T, Yang Y, Lu Q, Gao B, Chen Z, Wang Z. Efficacy and Safety of Monoclonal Antibody Therapy in Neuromyelitis Optica Spectrum Disorders: Evidence from Randomized Controlled Trials. Mult Scler Relat Disord 2020; 43:102166. [DOI: 10.1016/j.msard.2020.102166] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 04/10/2020] [Accepted: 04/27/2020] [Indexed: 12/13/2022]
|
21
|
Monoclonal Antibody-Based Treatments for Neuromyelitis Optica Spectrum Disorders: From Bench to Bedside. Neurosci Bull 2020; 36:1213-1224. [PMID: 32533450 DOI: 10.1007/s12264-020-00525-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Accepted: 04/10/2020] [Indexed: 12/20/2022] Open
Abstract
Neuromyelitis optica (NMO)/NMO spectrum disorder (NMOSD) is a chronic, recurrent, antibody-mediated, inflammatory demyelinating disease of the central nervous system, characterized by optic neuritis and transverse myelitis. The binding of NMO-IgG with astrocytic aquaporin-4 (AQP4) functions directly in the pathogenesis of >60% of NMOSD patients, and causes astrocyte loss, secondary inflammatory infiltration, demyelination, and neuron death, potentially leading to paralysis and blindness. Current treatment options, including immunosuppressive agents, plasma exchange, and B-cell depletion, are based on small retrospective case series and open-label studies. It is noteworthy that monoclonal antibody (mAb) therapy is a better option for autoimmune diseases due to its high efficacy and tolerability. Although the pathophysiological mechanisms of NMOSD remain unknown, increasingly, therapeutic studies have focused on mAbs, which target B cell depletion, complement and inflammation cascade inactivation, blood-brain-barrier protection, and blockade of NMO-IgG-AQP4 binding. Here, we review the targets, characteristics, mechanisms of action, development, and potential efficacy of mAb trials in NMOSD, including preclinical and experimental investigations.
Collapse
|
22
|
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.
Collapse
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
| |
Collapse
|
23
|
Poupart J, Giovannelli J, Deschamps R, Audoin B, Ciron J, Maillart E, Papeix C, Collongues N, Bourre B, Cohen M, Wiertlewski S, Outteryck O, Laplaud D, Vukusic S, Marignier R, Zephir H. Evaluation of efficacy and tolerability of first-line therapies in NMOSD. Neurology 2020; 94:e1645-e1656. [DOI: 10.1212/wnl.0000000000009245] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Accepted: 10/21/2019] [Indexed: 11/15/2022] Open
Abstract
ObjectiveTo compare the efficacy and the risk of severe infectious events of immunosuppressive agents used early as first-line therapy in patients with neuromyelitis optica spectrum disorder (NMOSD).MethodsWe retrospectively included patients with NMOSD and a seropositive status for aquaporin 4 or myelin oligodendrocyte glycoprotein antibodies beginning first-line immunosuppressants within 3 years after the disease onset. The main outcome was occurrence of relapse after the initiation of immunosuppressants; the secondary outcome was the annual relapse rate (AAR).ResultsA total of 136 patients were included: 62 (45.6%) were treated with rituximab (RTX), 42 (30.9%) with mycophenolate mofetil (MMF), and 23 (16.9%) with azathioprine (AZA). Compared with RTX-treated patients, the risk of relapse was higher among MMF-treated patients (hazard ratio [HR], 2.74 [1.17–6.40]; p = 0.020) after adjusting for age at disease onset, sex, antibody status, disease duration, ARR before treatment, corticosteroid intake, and relapse location. We did not observe any difference between RTX-treated and AZA-treated patients (HR, 2.13 [0.72–6.28]; p = 0.17). No interaction was found between the antibody status and immunosuppressive treatments. ARR was lower with RTX than with MMF (p = 0.039), but no difference was observed with AZA. We observed 9 serious infectious events with MMF, 6 with RTX, and none with AZA.ConclusionsThe use of first-line RTX in NMOSD appears more effective than MMF in suppressing clinical activity, independent of the antibody status.Classification of evidenceThat study provides Class III evidence that for patients with NMOSD, first-line RTX is superior to MMF to reduce the risk of relapse.
Collapse
|
24
|
Aungsumart S, Apiwattanakul M. Cost effectiveness of rituximab and mycophenolate mofetil for neuromyelitis optica spectrum disorder in Thailand: Economic evaluation and budget impact analysis. PLoS One 2020; 15:e0229028. [PMID: 32050011 PMCID: PMC7015451 DOI: 10.1371/journal.pone.0229028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 01/28/2020] [Indexed: 01/01/2023] Open
Abstract
Neuromyelitis optica spectrum disorder (NMOSD) is an inflammatory condition of the central nervous system. The extent of disability depends on the severity of the disease and the number of relapses. Although azathioprine is currently the main treatment for patients with NMOSD in Thailand, patients often relapse during its use. Hence, it is argued that there are other drugs that would be more effective. The purpose of this study is to evaluate, from a societal perspective and from the economic impact on Thailand’s healthcare system, the cost utility of treatment with mycophenolate mofetil (MMF) and rituximab in patients resistant to azathioprine. The Markov model with a one-year cycle length was applied to predict the health and cost outcomes in patients with NMOSD over a lifetime. The results showed that rituximab exhibited the highest quality-adjusted life year (QALY) gains among all the options. Among the rituximab-based treatments, the administration of a rituximab biosimilar with CD27+ memory B cell monitoring proved to be the most cost-effective option. At the willingness-to-pay threshold of 160,000 Thai baht (THB), or 5,289 US dollar (USD), per QALY gained, the treatment exhibited the highest probability of being cost effective (48%). A sensitivity analysis based on the adjusted price of a generic MMF determined that the treatment was cost effective, exhibiting an incremental cost-effectiveness ratio of -164,653 THB (-5,443 USD) and a 32% probability of being cost effective. The calculated budget impact of treating patients resistant to conventional therapy was 1–6 million THB (33,000–198,000 USD) for the first three years, while after the third year, the budget impact stabilized at 3–4 million THB (99,000–132,000 USD). These data indicate that, in Thailand, treatment of drug resistant NMOSD with a rituximab biosimilar with CD27+ memory B cell monitoring or treatment with a generic MMF would be cost effective and would result in a low budget impact. Therefore, the inclusion of both the rituximab biosimilar and a generic MMF in the National Drug List of Essential Medicine for the treatment of NMOSD may be appropriate.
Collapse
Affiliation(s)
- Saharat Aungsumart
- Neuroimmunology Unit, Department of Neurology, Prasat Neurological Institute, Bangkok, Thailand
- * E-mail:
| | - Metha Apiwattanakul
- Neuroimmunology Unit, Department of Neurology, Prasat Neurological Institute, Bangkok, Thailand
| |
Collapse
|
25
|
Post-rituximab immunoglobulin M (IgM) hypogammaglobulinemia. Autoimmun Rev 2020; 19:102466. [PMID: 31917267 DOI: 10.1016/j.autrev.2020.102466] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 09/30/2019] [Indexed: 12/19/2022]
Abstract
Rituximab is a B cell depleting monoclonal antibody that targets the B cell-specific cell surface antigen CD20 and is currently used to treat several autoimmune diseases. The elimination of mature CD20-positive B lymphocytes committed to differentiate into autoantibody-producing plasma cells is considered to be the major effect of rituximab, that makes it a beneficial biological agent in treating autoimmune diseases. Hypogammaglobulinemia has been reported after rituximab therapy in patients with lymphoma and rheumatoid arthritis. Similar data are scarce for other autoimmune diseases. Low immunoglobulin G (IgG) or hypogammaglobulinemia has attracted the most attention because of its significant role in protective immunity. However, the incidence and clinical implications of low immunoglobulin M (IgM) or hypogammaglobulinemia have not been studied in detail. This review will focus on the frequency and the clinical concerns of low IgM levels that result as a consequence of the administration of rituximab. The etiopathogenic mechanisms underlying post-rituximab IgM hypogammaglobulinemia and its implications are presented. The long-term consequences, if any, are not known or documented. Multiple factors may be involved in whether IgG or IgM decreases secondary to rituximab therapy. It is possible that the autoimmune disease itself may be one of the important factors. The dose, frequency and number of infusions appear to be important variables. Post-rituximab therapy immunoglobulin levels return to normal. During this process. IgM levels take a longer time to return to normal levels when compared to IgG or other immunoglobulins. IgM deficiency persists after B cell repopulation to normal levels has occurred. Laboratory animals and humans deficient in IgM can have multiple infections. Specific pharmacologic agents or biologic therapy that address and resolve IgM deficiency are currently unavailable. If the clinical situation so warrants, then prophylactic antibiotics may be indicated and perhaps helpful. Research in this iatrogenic phenomenon will provide a better understanding of not only the biology of IgM, but also the factor(s) that control its production and regulation, besides its influence if any, on rituximab therapy.
Collapse
|
26
|
Durozard P, Rico A, Boutiere C, Maarouf A, Lacroix R, Cointe S, Fritz S, Brunet C, Pelletier J, Marignier R, Audoin B. Comparison of the Response to Rituximab between Myelin Oligodendrocyte Glycoprotein and Aquaporin-4 Antibody Diseases. Ann Neurol 2019; 87:256-266. [PMID: 31725931 DOI: 10.1002/ana.25648] [Citation(s) in RCA: 87] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 11/11/2019] [Accepted: 11/12/2019] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To compare response to rituximab (RTX) between adult patients positive for myelin oligodendrocyte glycoprotein (MOG) and aquaporin-4 (AQP4) antibodies. METHODS We prospectively studied adult patients with MOG or AQP4 antibodies who received RTX under an individualized dosing schedule adapted to the biological effect of RTX monitored by memory B-cell measurement. Memory B cells were counted monthly and when relapse occurred. The biological effect of RTX was considered significant with <0.05% memory B cells in peripheral blood lymphocytes. RESULTS In 16 patients with MOG antibodies and 29 with AQP4 antibodies, mean follow-up was 19 (range = 9-38) and 38 (13-79) months. Under RTX, 10 relapses occurred in 6 of 16 (37.5%) patients with MOG antibodies, and 13 occurred in 7 of 29 (24%) with AQP4 antibodies. The median time of relapse after the most recent infusion was 2.6 (0.6-5.8) and 7 (0.8-13) months, respectively (p < 0.001). Memory B cells had reemerged in 2 of 10 (20%) relapses in patients with MOG antibodies and 12 of 13 (92.5%) with AQP4 antibodies (p < 0.001). INTERPRETATION In AQP4 antibody-associated disorder, relapse mostly occurs when the biological effect of RTX decreases, which argues for treatment efficacy. In MOG antibody-associated disorder, the efficacy of RTX is not constant, because one-third of patients showed relapse despite an effective biological effect of RTX. In this subpopulation, memory B-cell depletion was unable to prevent relapse, which was probably caused by different immunological mechanisms. These findings should be used to improve treatment strategies for MOG antibody-associated disorder. ANN NEUROL 2020;87:256-266.
Collapse
Affiliation(s)
- Pierre Durozard
- Public Assistance Hospitals of Marseille, Department of Neurology, Timone Hospital, Marseille.,Aix-Marseille University, Center for Magnetic Resonance in Biology and Medicine, French National Center for Scientific Research, Marseille
| | - Audrey Rico
- Public Assistance Hospitals of Marseille, Department of Neurology, Timone Hospital, Marseille.,Aix-Marseille University, Center for Magnetic Resonance in Biology and Medicine, French National Center for Scientific Research, Marseille
| | - Clémence Boutiere
- Public Assistance Hospitals of Marseille, Department of Neurology, Timone Hospital, Marseille.,Aix-Marseille University, Center for Magnetic Resonance in Biology and Medicine, French National Center for Scientific Research, Marseille
| | - Adil Maarouf
- Public Assistance Hospitals of Marseille, Department of Neurology, Timone Hospital, Marseille.,Aix-Marseille University, Center for Magnetic Resonance in Biology and Medicine, French National Center for Scientific Research, Marseille
| | - Romaric Lacroix
- Public Assistance Hospitals of Marseille, Laboratory of Hematology and Vascular Biology, La Conception Hospital, Marseille.,Aix-Marseille University, Center for Cardiovascular and Nutrition Research, French National Institute of Health, National Institute of Agricultural Research, Faculty of Pharmacy, Marseille
| | - Sylvie Cointe
- Public Assistance Hospitals of Marseille, Laboratory of Hematology and Vascular Biology, La Conception Hospital, Marseille.,Aix-Marseille University, Center for Cardiovascular and Nutrition Research, French National Institute of Health, National Institute of Agricultural Research, Faculty of Pharmacy, Marseille
| | - Shirley Fritz
- Public Assistance Hospitals of Marseille, Laboratory of Hematology and Vascular Biology, La Conception Hospital, Marseille.,Aix-Marseille University, Center for Cardiovascular and Nutrition Research, French National Institute of Health, National Institute of Agricultural Research, Faculty of Pharmacy, Marseille
| | - Corinne Brunet
- Public Assistance Hospitals of Marseille, Laboratory of Hematology and Vascular Biology, La Conception Hospital, Marseille.,Aix-Marseille University, Center for Cardiovascular and Nutrition Research, French National Institute of Health, National Institute of Agricultural Research, Faculty of Pharmacy, Marseille
| | - Jean Pelletier
- Public Assistance Hospitals of Marseille, Department of Neurology, Timone Hospital, Marseille.,Aix-Marseille University, Center for Magnetic Resonance in Biology and Medicine, French National Center for Scientific Research, Marseille
| | - Romain Marignier
- Lyon Civil Hospices, Department of Neurology, Neurologic and Neurosurgical Hospital Pierre Wertheimer, Bron, France
| | - Bertrand Audoin
- Public Assistance Hospitals of Marseille, Department of Neurology, Timone Hospital, Marseille
| |
Collapse
|
27
|
Wu K, Wen L, Duan R, Li Y, Yao Y, Jing L, Jia Y, Teng J, He Q. Triglyceride Level Is an Independent Risk Factor in First-Attacked Neuromyelitis Optica Spectrum Disorders Patients. Front Neurol 2019; 10:1230. [PMID: 31824407 PMCID: PMC6881454 DOI: 10.3389/fneur.2019.01230] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Accepted: 11/05/2019] [Indexed: 12/17/2022] Open
Abstract
Objective: To investigate prospective associations between triglyceride (TG) level and prognosis of first-attacked patients with neuromyelitis optica spectrum disorders (NMOSD). Methods: This retrospective study included 196 patients newly diagnosed with NMOSD from June 2014 to December 2018. Data of clinical parameters, including age of onset, sex, BMI, blood lipid levels, anti-aquaporin-4 status, serum glucose level, therapy regimens, comorbidities, initial Expanded Disability Status Scale (EDSS), relapses, and outcomes were collected. We used logistic regression models to examine the associations among relevant clinical factors and outcomes, and statistical analyses were performed using the SPSS 23.0 software. Results: Compared with the high TG group, residual EDSS was relatively lower in the normal TG group (median 1.0 vs. 2.0, P = 0.002). In the univariate analysis, TG level was positively correlated with outcomes (OR 1.75, 95% CI 1.18-2.60, P = 0.005) and relapses (OR 1.57, 95% CI 1.07-2.31, P = 0.02). Our stratified analysis suggested that patients with normal BMI (OR 4.90, 95% CI 2.10-11.44, P = 0.001) were closely correlated with poor recovery owing to increased TG level. In the multivariate analysis, a statistically significant association still existed between TG level and outcomes (OR 3.44, 95% CI 1.02-11.64; P = 0.040) after adjusting for various variables. Conclusions: In first-attacked NMOSD patients, TG level was positively associated with poor recovery. Early monitoring and treatment of elevated TG level in NMOSD patients are important.
Collapse
Affiliation(s)
- Kaimin Wu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - LuLu Wen
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ranran Duan
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yanfei Li
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yaobing Yao
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Lijun Jing
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yanjie Jia
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Junfang Teng
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Qianyi He
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| |
Collapse
|
28
|
Pharmacotherapy for Neuromyelitis Optica Spectrum Disorders: Current Management and Future Options. Drugs 2019; 79:125-142. [PMID: 30623348 DOI: 10.1007/s40265-018-1039-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Neuromyelitis optica (NMO) is an inflammatory and demyelinating disease of the central nervous system. Although the prevalence of NMO is low, the rapid and severe impairment observed in patients has led to extensive development of research in the fields of diagnostic criteria and therapy in the past 15 years. With improved understanding of the pathophysiology of NMO and the role of aquaporin-4 (AQP4) or myelin oligodendrocyte glycoprotein antibodies, numerous therapeutic approaches have been proposed and are currently undergoing evaluation. In this review, we describe the rationale for existing therapeutics and their benefit/risk ratio. We also discuss the pharmacological and clinical interest of future approaches targeting, among others, B or T cells, the blood-central nervous system barrier, complement, polynuclear cells, AQP4-antibody linkage and AQP4 activity. The numerous agents under development are the result of a major collaborative effort all over the world. After the considerable progress on diagnosis, we are now close to class I evidence for a therapeutic effect of several drugs in NMO spectrum disorders, most notably with the anti-interleukin-6 receptor antibody (satralizumab) and anti-complement-5 antibody (eculizumab).
Collapse
|
29
|
Cobo-Calvo A, Sepúlveda M, Rollot F, Armangué T, Ruiz A, Maillart E, Papeix C, Audoin B, Zephir H, Biotti D, Ciron J, Durand-Dubief F, Collongues N, Ayrignac X, Labauge P, Thouvenot E, Bourre B, Montcuquet A, Cohen M, Deschamps R, Solà-Valls N, Llufriu S, De Seze J, Blanco Y, Vukusic S, Saiz A, Marignier R. Evaluation of treatment response in adults with relapsing MOG-Ab-associated disease. J Neuroinflammation 2019; 16:134. [PMID: 31266527 PMCID: PMC6607517 DOI: 10.1186/s12974-019-1525-1] [Citation(s) in RCA: 99] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 06/19/2019] [Indexed: 12/21/2022] Open
Abstract
Background Myelin oligodendrocyte glycoprotein antibodies (MOG-Ab) are related to several acquired demyelinating syndromes in adults, but the therapeutic approach is currently unclear. We aimed to describe the response to different therapeutic strategies in adult patients with relapsing MOG-Ab-associated disease. Methods This is a retrospective study conducted in France and Spain including 125 relapsing MOG-Ab patients aged ≥ 18 years. First, we performed a survival analysis to investigate the relapse risk between treated and non-treated patients, performing a propensity score method based on the inverse probability of treatment weighting. Second, we assessed the annualised relapse rates (ARR), Expanded Disability Status Scale (EDSS) and visual acuity pre-treatment and on/end-treatment. Results Median age at onset was 34.1 years (range 18.0–67.1), the female to male ratio was 1.2:1, and 96% were Caucasian. At 5 years, 84% (95% confidence interval [CI], 77.1–89.8) patients relapsed. At the last follow-up, 66 (52.8%) received maintenance therapy. Patients initiating immunosuppressants (azathioprine, mycophenolate mophetil [MMF], rituximab) were at lower risk of new relapse in comparison to non-treated patients (HR, 0.41; 95CI%, 0.20–0.82; p = 0.011). Mean ARR (standard deviation) was reduced from 1.05(1.20) to 0.43(0.79) with azathioprine (n = 11; p = 0.041), from 1.20(1.11) to 0.23(0.60) with MMF (n = 11; p = 0.033), and from 1.08(0.98) to 0.43(0.89) with rituximab (n = 26; p = 0.012). Other immunosuppressants (methotrexate/mitoxantrone/cyclophosphamide; n = 5), or multiple sclerosis disease-modifying drugs (MS-DMD; n = 9), were not associated with significantly reduced ARR. Higher rates of freedom of EDSS progression were observed with azathioprine, MMF or rituximab. Conclusion In adults with relapsing MOG-Ab-associated disease, immunosuppressant therapy (azathioprine, MMF and rituximab) is associated with reduced risk of relapse and better disability outcomes. Such an effect was not found in the few patients treated with MS-DMD. Electronic supplementary material The online version of this article (10.1186/s12974-019-1525-1) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Alvaro Cobo-Calvo
- Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro-Inflammation, Hôpital Neurologique Pierre Wertheimer Hospices Civils de Lyon, Lyon, France.,Lyon Neuroscience Research Center, U1028 INSERM, UMR5292 CNRS, FLUID Team, 59 boulevard Pinel, 69677 Bron cedex, Lyon, France.,Centre de référence des maladies inflammatoires rares du cerveau et de la moelle (MIRCEM), Lyon, France
| | - María Sepúlveda
- Center of Neuroimmunology, Service of Neurology, Hospital Clinic and Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Fabien Rollot
- Faculté de Médecine Lyon-Est, Université Claude Bernard Lyon 1, Lyon, France.,Observatoire Francais de la Sclérose En Plaques (OFSEP), Hôpital Pierre-Wertheimer, Bron, France
| | - Thais Armangué
- Center of Neuroimmunology, Service of Neurology, Hospital Clinic and Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain.,Pediatric Neuroimmunology Unit, Department of Neurology, Sant Joan de Deu Children's Hospital, University of Barcelona, Barcelona, Spain
| | - Anne Ruiz
- Lyon Neuroscience Research Center, U1028 INSERM, UMR5292 CNRS, FLUID Team, 59 boulevard Pinel, 69677 Bron cedex, Lyon, France
| | - Elisabeth Maillart
- Department of Neurology, Pitié-Salpêtrière Hospital, APHP, Paris, France
| | - Caroline Papeix
- Department of Neurology, Pitié-Salpêtrière Hospital, APHP, Paris, France
| | - Bertrand Audoin
- Aix Marseille University, APHM, Hôpital de La Timone, Pôle de Neurosciences Cliniques, Service de Neurologie, Marseille, France
| | - Helene Zephir
- Pôle des Neurosciences et de l'Appareil Locomoteur, CHU de Lille, Université de Lille, LIRIC, UMR 995, Lille, France
| | - Damien Biotti
- Department of Neurology, Hôpital Pierre-Paul Riquet, University Hospital of Toulouse, Toulouse, France
| | - Jonathan Ciron
- Department of Neurology, Hôpital Pierre-Paul Riquet, University Hospital of Toulouse, Toulouse, France
| | - Francoise Durand-Dubief
- Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro-Inflammation, Hôpital Neurologique Pierre Wertheimer Hospices Civils de Lyon, Lyon, France
| | - Nicolas Collongues
- Department of Neurology and Clinical Investigation Center, Strasbourg University Hospital, Strasbourg, France
| | - Xavier Ayrignac
- Multiple Sclerosis Clinic, Montpellier University Hospital, Montpellier, France
| | - Pierre Labauge
- Multiple Sclerosis Clinic, Montpellier University Hospital, Montpellier, France
| | - Eric Thouvenot
- Department of Neurology, Hôpital Carémeau, Nimes University Hospital, Nimes, France
| | - Bertrand Bourre
- Department of Neurology, Rouen University Hospital, Rouen, France
| | | | - Mikael Cohen
- Université Côte d'Azur, Hôpital Pasteur 2, Centre Hospitalier Universitaire de Nice, Service de Neurologie, Nice, France
| | - Romain Deschamps
- Department of Neurology, Fondation A. De Rothschild, Paris, France
| | - Nuria Solà-Valls
- Center of Neuroimmunology, Service of Neurology, Hospital Clinic and Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Sara Llufriu
- Center of Neuroimmunology, Service of Neurology, Hospital Clinic and Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Jerome De Seze
- Department of Neurology and Clinical Investigation Center, Strasbourg University Hospital, Strasbourg, France
| | - Yolanda Blanco
- Center of Neuroimmunology, Service of Neurology, Hospital Clinic and Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Sandra Vukusic
- Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro-Inflammation, Hôpital Neurologique Pierre Wertheimer Hospices Civils de Lyon, Lyon, France.,Centre de référence des maladies inflammatoires rares du cerveau et de la moelle (MIRCEM), Lyon, France
| | - Albert Saiz
- Center of Neuroimmunology, Service of Neurology, Hospital Clinic and Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Romain Marignier
- Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro-Inflammation, Hôpital Neurologique Pierre Wertheimer Hospices Civils de Lyon, Lyon, France. .,Lyon Neuroscience Research Center, U1028 INSERM, UMR5292 CNRS, FLUID Team, 59 boulevard Pinel, 69677 Bron cedex, Lyon, France. .,Centre de référence des maladies inflammatoires rares du cerveau et de la moelle (MIRCEM), Lyon, France.
| |
Collapse
|
30
|
Gao F, Chai B, Gu C, Wu R, Dong T, Yao Y, Zhang Y. Effectiveness of rituximab in neuromyelitis optica: a meta-analysis. BMC Neurol 2019; 19:36. [PMID: 30841862 PMCID: PMC6402122 DOI: 10.1186/s12883-019-1261-2] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 02/19/2019] [Indexed: 01/06/2023] Open
Abstract
Background Neuromyelitis optica (NMO) is a severe inflammatory autoimmune disorder of the central nervous system and often results in paralysis or blindness. Rituximab (RTX) is a mouse–human chimeric monoclonal antibody specific for the CD20 antigen on B lymphocytes and used to treat many autoimmune diseases. Disability and relapses were measured using the Expanded Disability Status Scale (EDSS) and annualized relapse rate (ARR) ratio to evaluate the effectiveness of RTX. This review performed a meta-analysis of the efficacy of RTX in NMO. Methods We searched through the databases of PubMed, Embase, and Cochrane Library. We compiled 26 studies, in which 18 used ARR ratio, 22 used EDSS score, and 14 used both variables. Differences in the ARR ratio and EDSS score before and after RTX therapy were used as the main efficacy measures. Publication bias was evaluated after the consistency test, and a sensitivity analysis was performed with mean difference (MD) of the efficacy of RTX. Results A meta-analysis of 26 studies with 577 participants was conducted. Antibodies against aquaporin-4 autoantibody were recorded in 435 of 577 (75.39%) patients with NMO. RTX therapy resulted in a mean (WMD) − 1.56 (95% CI, − 1.82 to − 1.29) reduction in the mean ARR ratio and a mean (WMD) − 1.16 (95% CI, − 1.36 to − 0.96) reduction in the mean EDSS score. A total of 330 of 528 patients (62.9%) reached the relapse-free state. A total of 95 of 577 (16.46%) patients had adverse reactions. Conclusions RTX has acceptable tolerance, reduces the relapse frequency, and improves disability in most patients with NMO. Future studies should focus on reducing the health-care costs, improving the functional outcomes, and reducing the adverse effects associated with RTX treatment.
Collapse
Affiliation(s)
- Fulin Gao
- Department of Neurology, Gansu Provincial Hospital, No. 204 of Donggang West Road, Lanzhou City, Gansu province, 730000, People's Republic of China.,School of Clinical Medicine, Gansu university of Traditional Chinese medicine, No. 35 of Dingxi East Road, Lanzhou City, Gansu province, 730000, People's Republic of China
| | - Bingyan Chai
- School of Clinical Medicine, Gansu university of Traditional Chinese medicine, No. 35 of Dingxi East Road, Lanzhou City, Gansu province, 730000, People's Republic of China
| | - Cheng Gu
- Department of Neurology, Gansu Provincial Hospital, No. 204 of Donggang West Road, Lanzhou City, Gansu province, 730000, People's Republic of China
| | - Ruipeng Wu
- Department of Neurology, Gansu Provincial Hospital, No. 204 of Donggang West Road, Lanzhou City, Gansu province, 730000, People's Republic of China
| | - Tong Dong
- Department of Neurology, Gansu Provincial Hospital, No. 204 of Donggang West Road, Lanzhou City, Gansu province, 730000, People's Republic of China
| | - Yuping Yao
- Department of Neurology, Gansu Provincial Hospital, No. 204 of Donggang West Road, Lanzhou City, Gansu province, 730000, People's Republic of China
| | - Yi Zhang
- Department of Neurology, Gansu Provincial Hospital, No. 204 of Donggang West Road, Lanzhou City, Gansu province, 730000, People's Republic of China.
| |
Collapse
|
31
|
Kim SH, Hyun JW, Kim HJ. Individualized B cell-targeting therapy for neuromyelitis optica spectrum disorder. Neurochem Int 2018; 130:104347. [PMID: 30513364 DOI: 10.1016/j.neuint.2018.11.022] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 11/12/2018] [Accepted: 11/30/2018] [Indexed: 12/23/2022]
Abstract
Neuromyelitis optica spectrum disorder (NMOSD) is an autoimmune inflammatory disease of the central nervous system characterized by severe attacks of optic neuritis (ON), longitudinally extensive transverse myelitis (LETM), and area postrema syndrome. The majority of patients with NMOSD are seropositive for autoantibodies against the astrocyte water channel aquaporin-4 (AQP4). As convergent clinical and laboratory-based investigations have indicated that B cells play a fundamental role in NMO immunopathology, B cells have become an attractive therapeutic target. Rituximab is a therapeutic monoclonal antibody against CD20 expressed on B cells and increasingly used for the treatment of NMOSD. Although there is robust evidence for the efficacy and safety of rituximab in NMOSD, considerable variability has been noted in biological and clinical responses in patients. Therefore, the focus now is on understanding the mechanisms underlying the variability in response to rituximab and optimizing the use of rituximab for NMOSD. Identification of biomarkers for prediction of clinical response, and effective dosing and timing of treatment may provide useful tools for patient-tailored treatment in NMOSD. Herein, we review current evidence on factors that affect biological and clinical responses to rituximab and highlight the importance of individualized therapies for NMOSD.
Collapse
Affiliation(s)
- Su-Hyun Kim
- Department of Neurology, Research Institute and Hospital of National Cancer Center, Republic of Korea
| | - Jae-Won Hyun
- Department of Neurology, Research Institute and Hospital of National Cancer Center, Republic of Korea
| | - Ho Jin Kim
- Department of Neurology, Research Institute and Hospital of National Cancer Center, Republic of Korea.
| |
Collapse
|
32
|
Smith TJ. Is there potential for the approval of monoclonal antibodies to treat thyroid-associated ophthalmopathy? Expert Opin Orphan Drugs 2018; 6:593-595. [PMID: 31662952 DOI: 10.1080/21678707.2018.1521268] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Terry J Smith
- University of Michigan Ringgold standard institution - Ophthalmology and Visual Sciences, Ann Arbor, Michigan, USA
| |
Collapse
|
33
|
Casan JML, Wong J, Northcott MJ, Opat S. Anti-CD20 monoclonal antibodies: reviewing a revolution. Hum Vaccin Immunother 2018; 14:2820-2841. [PMID: 30096012 PMCID: PMC6343614 DOI: 10.1080/21645515.2018.1508624] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 07/14/2018] [Accepted: 08/02/2018] [Indexed: 12/23/2022] Open
Abstract
Since the inception of rituximab in the 1990s, anti-CD20 monoclonal antibodies have revolutionised the treatment of B cell hematological malignancies and have become a cornerstone of modern gold-standard practice. Additionally, the potent efficacy of these agents in depleting the B cell compartment has been used in the management of a broad array of autoimmune diseases. Multiple iterations of these agents have been investigated and are routinely used in clinical practice. In this review, we will discuss the physiology of CD20 and its attractiveness as a therapeutic target, as well as the pharmacology, pre-clinical and clinical data for the major anti-CD20 monoclonal antibodies: rituximab, obinutuzumab and ofatumumab.
Collapse
Affiliation(s)
- J. M. L. Casan
- Haematology Department, Monash Health, Melbourne Australia
| | - J. Wong
- Haematology Department, Monash Health, Melbourne Australia
| | - M. J. Northcott
- Rheumatology Department, Monash Health, Melbourne, Australia
- School of Clinical Sciences, Monash University, Melbourne, Australia
| | - S. Opat
- Haematology Department, Monash Health, Melbourne Australia
- School of Clinical Sciences, Monash University, Melbourne, Australia
| |
Collapse
|
34
|
Only Follow-Up of Memory B Cells Helps Monitor Rituximab Administration to Patients with Neuromyelitis Optica Spectrum Disorders. Neurol Ther 2018; 7:373-383. [PMID: 29881979 PMCID: PMC6283795 DOI: 10.1007/s40120-018-0101-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Indexed: 01/01/2023] Open
Abstract
Introduction Neuromyelitis optica spectrum disorders (NMOSD) are identified as a spectrum of inflammatory demyelinating disorders involving the brain, spinal cord and optic nerves. These disorders require early diagnosis and highly active immunosuppressive treatment. Rituximab (RTX) has demonstrated efficacy in limiting relapse in NMOSD when using several administration schedules. We questioned if the CD19+ CD27+ memory B cell count was a more reliable marker to monitor RTX administration than the RTX plasma level and CD19+ B cell count. Methods We analyzed 125 blood samples from 17 NMOSD patients treated with RTX and also measured the level of anti-aquaporine-4 antibodies (anti-AQP-4 Abs), human anti-chimeric antibodies to the murine fragment of RTX (HACA-RTX Abs), and the RTX concentration. Results The mean follow-up time of the cohort was 7.4 (2–16) years. All patients improved with a mean EDSS going from 4 (1–8.5) to 2.7 (1–5.5). The mean interval between RTX infusions was 9.6 months with identification of prolonged responders. Total CD19+ B cell detection with the routine technique did not correlate to re-emergence of CD19+ CD27+ memory B cells. The RTX residual concentration did not correlate with the CD19+ CD27+ memory B cell count or with anti-RTX antibody production. Conclusion In contrast to total CD19+ cell, detected with the routine technique, CD19+ CD27+ memory B cells are a reliable marker for biological relapse and allow a decrease in the frequency of infusions.
Collapse
|
35
|
Pierpont TM, Limper CB, Richards KL. Past, Present, and Future of Rituximab-The World's First Oncology Monoclonal Antibody Therapy. Front Oncol 2018; 8:163. [PMID: 29915719 PMCID: PMC5994406 DOI: 10.3389/fonc.2018.00163] [Citation(s) in RCA: 213] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 04/30/2018] [Indexed: 12/13/2022] Open
Abstract
Rituximab is a chimeric mouse/human monoclonal antibody (mAb) therapy with binding specificity to CD20. It was the first therapeutic antibody approved for oncology patients and was the top-selling oncology drug for nearly a decade with sales reaching $8.58 billion in 2016. Since its initial approval in 1997, it has improved outcomes in all B-cell malignancies, including diffuse large B-cell lymphoma, follicular lymphoma, and chronic lymphocytic leukemia. Despite widespread use, most mechanistic data have been gathered from in vitro studies while the roles of the various response mechanisms in humans are still largely undetermined. Polymorphisms in Fc gamma receptor and complement protein genes have been implicated as potential predictors of differential response to rituximab, but have not yet shown sufficient influence to impact clinical decisions. Unlike most targeted therapies developed today, no known biomarkers to indicate target engagement/tumor response have been identified, aside from reduced tumor burden. The lack of companion biomarkers beyond CD20 itself has made it difficult to predict which patients will respond to any given anti-CD20 antibody. In the past decade, two new anti-CD20 antibodies have been approved: ofatumumab, which binds a distinct epitope of CD20, and obinutuzumab, a mAb derived from rituximab with modifications to the Fc portion and to its glycosylation. Both are fully humanized and have biological activity that is distinct from that of rituximab. In addition to these new anti-CD20 antibodies, another imminent change in targeted lymphoma treatment is the multitude of biosimilars that are becoming available as rituximab's patent expires. While the widespread use of rituximab itself will likely continue, its biosimilars will increase global access to the therapy. This review discusses current research into mechanisms and potential biomarkers of rituximab response, as well as its biosimilars and the newer CD20 binding mAb therapies. Increased ability to assess the effectiveness of rituximab in an individual patient, along with the availability of alternative anti-CD20 antibodies will likely lead to dramatic changes in how we use CD20 antibodies going forward.
Collapse
Affiliation(s)
- Timothy M. Pierpont
- Richards Laboratory, Department of Biomedical Sciences, Cornell University, Ithaca, NY, United States
| | - Candice B. Limper
- Richards Laboratory, Department of Biomedical Sciences, Cornell University, Ithaca, NY, United States
| | - Kristy L. Richards
- Richards Laboratory, Department of Biomedical Sciences, Cornell University, Ithaca, NY, United States
- Department of Medicine, Sandra and Edward Meyer Cancer Center, Weill Cornell Medicine, New York, NY, United States
| |
Collapse
|
36
|
Low-dosage of rituximab in Chinese patients with neuromyelitis optica spectrum disorder. J Neuroimmunol 2018; 317:1-4. [DOI: 10.1016/j.jneuroim.2018.02.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 11/28/2017] [Accepted: 02/05/2018] [Indexed: 12/21/2022]
|
37
|
Ciron J, Audoin B, Bourre B, Brassat D, Durand-Dubief F, Laplaud D, Maillart E, Papeix C, Vukusic S, Zephir H, Marignier R, Collongues N. Recommendations for the use of Rituximab in neuromyelitis optica spectrum disorders. Rev Neurol (Paris) 2018; 174:255-264. [DOI: 10.1016/j.neurol.2017.11.005] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 11/07/2017] [Indexed: 01/08/2023]
|
38
|
Treatment of neuromyelitis optica with rituximab: a 2-year prospective multicenter study. J Neurol 2018; 265:917-925. [PMID: 29455361 DOI: 10.1007/s00415-018-8771-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 01/26/2018] [Accepted: 01/27/2018] [Indexed: 01/06/2023]
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.
Collapse
|
39
|
Yang Y, Wang CJ, Wang BJ, Zeng ZL, Guo SG. Comparison of efficacy and tolerability of azathioprine, mycophenolate mofetil, and lower dosages of rituximab among patients with neuromyelitis optica spectrum disorder. J Neurol Sci 2017; 385:192-197. [PMID: 29406904 DOI: 10.1016/j.jns.2017.12.034] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 12/23/2017] [Accepted: 12/27/2017] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To observe and compare the efficacy and tolerability of azathioprine (AZA), mycophenolate mofetil (MMF) and lower dosages of rituximab (RTX) among patients with neuromyelitis optica spectrum disorder. METHODS In this prospective cohort, AQP4-IgG-seropositive patients with neuromyelitis optica spectrum disorder (NMOSD) were enrolled and randomly divided into three groups, using AZA, MMF or lower dosages of RTX (defined as 100mg RTX intravenous injection, once per week for 4 consecutive weeks) respectively. Annualized relapse rate (ARR), EDSS scores, CD19+ B-cell counts in peripheral blood, serum AQP-4-IgG titre and drug adverse reactions were compared between three groups. RESULTS In the AZA group (n=22), MMF group (n=30) and RTX group (n=20), 54.5%, 60.0% and 65.0% of patients reached a relapse-free state and EDSS score improved in 90.9%, 83.3% and 90.0% of patients respectively. In addition, there was significant reduction in ARR in all the three groups. Reduced dosage of RTX exerted a significant effect in reducing CD19+ B-cell counts (P<0.01). Compared with the AZA group, the MMF group and the RTX group decreased the AQP-4-IgG titre evidently and caused fewer adverse events. Neither the Kaplan-Meier survival curves nor the Cox proportional hazard model indicated a significant difference in relapse among the three groups (P>0.05). CONCLUSIONS AZA, MMF and reduced dosages of rituximab are all effective in reducing ARR and improving the clinical symptom of patients with NMOSD. Lower dosages of RTX are more effective than the others in decreasing the CD19 B-cell counts. MMF and reduced RTX decrease AQP-4-IgG titre more and cause fewer adverse events than AZA. However, more multicentre studies are still needed to find more effective therapeutic regimen.
Collapse
Affiliation(s)
- Yang Yang
- Department of Neurology, Shandong Provincial Hospital affiliated to Shandong University, Jing Wu Road, Huaiyin District, Jinan 250021, Shandong, China
| | - Chun-Juan Wang
- Department of Neurology, Shandong Provincial Hospital affiliated to Shandong University, Jing Wu Road, Huaiyin District, Jinan 250021, Shandong, China
| | - Bao-Jie Wang
- Department of Neurology, Shandong Provincial Hospital affiliated to Shandong University, Jing Wu Road, Huaiyin District, Jinan 250021, Shandong, China
| | - Zi-Ling Zeng
- Department of Neurology, Shandong Provincial Hospital affiliated to Shandong University, Jing Wu Road, Huaiyin District, Jinan 250021, Shandong, China
| | - Shou-Gang Guo
- Department of Neurology, Shandong Provincial Hospital affiliated to Shandong University, Jing Wu Road, Huaiyin District, Jinan 250021, Shandong, China.
| |
Collapse
|
40
|
Abstract
Neuromyelitis optica (NMO), formerly known as Devic disease, is an autoimmune astrocytopathic disease characterized by transverse myelitis and optic neuritis. Most patients demonstrate a relapsing course with incomplete recovery between attacks, resulting in progressive disability. The pathogenesis involves production of aquaporin-4 antibodies (AQP4-IgG) by plasmablasts in peripheral circulation, disruption of the blood-brain barrier, complement-mediated astrocyte injury, and secondary demyelination. The diagnosis relies on characteristic clinical manifestations in the presence of serum AQP4-IgG positivity or specific neuroimaging findings, and exclusion of alternative etiologies. Current treatment involves aggressive immunosuppression with pulse-dose steroids during acute attacks and long-term immunosuppression for attack prevention.
Collapse
Affiliation(s)
- Sarah L Patterson
- Division of Rheumatology, Department of Medicine, University of California, San Francisco, 400 Parnassus Avenue, San Francisco, CA 94143, USA
| | - Sarah E Goglin
- Division of Rheumatology, Department of Medicine, University of California, San Francisco, 400 Parnassus Avenue, San Francisco, CA 94143, USA.
| |
Collapse
|
41
|
Stellmann JP, Krumbholz M, Friede T, Gahlen A, Borisow N, Fischer K, Hellwig K, Pache F, Ruprecht K, Havla J, Kümpfel T, Aktas O, Hartung HP, Ringelstein M, Geis C, Kleinschnitz C, Berthele A, Hemmer B, Angstwurm K, Young KL, Schuster S, Stangel M, Lauda F, Tumani H, Mayer C, Zeltner L, Ziemann U, Linker RA, Schwab M, Marziniak M, Then Bergh F, Hofstadt-van Oy U, Neuhaus O, Zettl U, Faiss J, Wildemann B, Paul F, Jarius S, Trebst C, Kleiter I. Immunotherapies in neuromyelitis optica spectrum disorder: efficacy and predictors of response. J Neurol Neurosurg Psychiatry 2017; 88:639-647. [PMID: 28572277 PMCID: PMC5537514 DOI: 10.1136/jnnp-2017-315603] [Citation(s) in RCA: 109] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Revised: 03/13/2017] [Accepted: 03/20/2017] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To analyse predictors for relapses and number of attacks under different immunotherapies in patients with neuromyelitis optica spectrum disorder (NMOSD). DESIGN This is a retrospective cohort study conducted in neurology departments at 21 regional and university hospitals in Germany. Eligible participants were patients with aquaporin-4-antibody-positive or aquaporin-4-antibody-negative NMOSD. Main outcome measures were HRs from Cox proportional hazard regression models adjusted for centre effects, important prognostic factors and repeated treatment episodes. RESULTS 265 treatment episodes with a mean duration of 442 days (total of 321 treatment years) in 144 patients (mean age at first attack: 40.9 years, 82.6% female, 86.1% aquaporin-4-antibody-positive) were analysed. 191 attacks occurred during any of the treatments (annual relapse rate=0.60). The most common treatments were rituximab (n=77, 111 patient-years), azathioprine (n=52, 68 patient-years), interferon-β (n=32, 61 patient-years), mitoxantrone (n=34, 32.1 patient-years) and glatiramer acetate (n=17, 10 patient-years). Azathioprine (HR=0.4, 95% CI 0.3 to 0.7, p=0.001) and rituximab (HR=0.6, 95% CI 0.4 to 1.0, p=0.034) reduced the attack risk compared with interferon-β, whereas mitoxantrone and glatiramer acetate did not. Patients who were aquaporin-4-antibody-positive had a higher risk of attacks (HR=2.5, 95% CI 1.3 to 5.1, p=0.009). Every decade of age was associated with a lower risk for attacks (HR=0.8, 95% CI 0.7 to 1.0, p=0.039). A previous attack under the same treatment tended to be predictive for further attacks (HR=1.5, 95% CI 1.0 to 2.4, p=0.065). CONCLUSIONS Age, antibody status and possibly previous attacks predict further attacks in patients treated for NMOSD. Azathioprine and rituximab are superior to interferon-β.
Collapse
Affiliation(s)
- Jan-Patrick Stellmann
- Institut für Neuroimmunologie und Multiple Sklerose (INIMS), Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany.,Klinik und Poliklinik für Neurologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Markus Krumbholz
- Institute of Clinical Neuroimmunology, Ludwig Maximilian University, Munich, Germany.,Department of Neurology and Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Tim Friede
- Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany
| | - Anna Gahlen
- Department of Neurology, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Nadja Borisow
- NeuroCure Clinical Research Center and Clinical and Experimental Multiple Sclerosis Research Center, Charité Universitätsmedizin Berlin, and Max Delbrueck Center for Molecular Medicine, Berlin, Germany
| | - Katrin Fischer
- Department of Neurology, Asklepios Fachklinikum Teupitz, Teupitz, Germany
| | - Kerstin Hellwig
- Department of Neurology, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Florence Pache
- NeuroCure Clinical Research Center and Clinical and Experimental Multiple Sclerosis Research Center, Charité Universitätsmedizin Berlin, and Max Delbrueck Center for Molecular Medicine, Berlin, Germany.,Department of Neurology and Clinical and Experimental Multiple Sclerosis Research Center, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Klemens Ruprecht
- Department of Neurology and Clinical and Experimental Multiple Sclerosis Research Center, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Joachim Havla
- Institute of Clinical Neuroimmunology, Ludwig Maximilian University, Munich, Germany
| | - Tania Kümpfel
- Institute of Clinical Neuroimmunology, Ludwig Maximilian University, Munich, Germany
| | - Orhan Aktas
- Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Hans-Peter Hartung
- Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Marius Ringelstein
- Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Christian Geis
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany.,Department of Neurology, Jena University Hospital, Jena, Germany
| | - Christoph Kleinschnitz
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany.,Department of Neurology, University Hospital Essen, Essen, Germany
| | - Achim Berthele
- Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Bernhard Hemmer
- Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Klemens Angstwurm
- Department of Neurology, University Hospital Regensburg, Regensburg, Germany
| | - Kim Lea Young
- Institut für Neuroimmunologie und Multiple Sklerose (INIMS), Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany.,Klinik und Poliklinik für Neurologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Simon Schuster
- Klinik und Poliklinik für Neurologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Stangel
- Clinical Neuroimmunology and Neurochemistry, Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Florian Lauda
- Department of Neurology, University of Ulm, Ulm, Germany
| | | | - Christoph Mayer
- Department of Neurology, Goethe University Frankfurt, Frankfurt, Germany
| | - Lena Zeltner
- Department of Neurology and Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Ulf Ziemann
- Department of Neurology and Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Ralf Andreas Linker
- Department of Neurology, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Matthias Schwab
- Department of Neurology, Jena University Hospital, Jena, Germany
| | - Martin Marziniak
- Department of Neurology, University of Münster, Münster, Germany
| | | | | | - Oliver Neuhaus
- Department of Neurology, SRH Krankenhaus Sigmaringen, Sigmaringen, Germany
| | - Uwe Zettl
- Department of Neurology, University of Rostock, Rostock, Germany
| | - Jürgen Faiss
- Department of Neurology, Asklepios Fachklinikum Teupitz, Teupitz, Germany
| | - Brigitte Wildemann
- Molecular Neuroimmunology Group, Department of Neurology, University of Heidelberg, Heidelberg, Germany
| | - Friedemann Paul
- NeuroCure Clinical Research Center and Clinical and Experimental Multiple Sclerosis Research Center, Charité Universitätsmedizin Berlin, and Max Delbrueck Center for Molecular Medicine, Berlin, Germany.,Department of Neurology and Clinical and Experimental Multiple Sclerosis Research Center, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Sven Jarius
- Molecular Neuroimmunology Group, Department of Neurology, University of Heidelberg, Heidelberg, Germany
| | - Corinna Trebst
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Ingo Kleiter
- Department of Neurology, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | | |
Collapse
|
42
|
Biotherapy in Inflammatory Diseases of the CNS: Current Knowledge and Applications. Curr Treat Options Neurol 2017; 19:19. [DOI: 10.1007/s11940-017-0456-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
|
43
|
Wang S, Yang T, Wan J, Zhang Y, Fan Y. Elevated C-X-C motif ligand 13 and B-cell-activating factor levels in neuromyelitis optica during remission. Brain Behav 2017; 7:e00648. [PMID: 28413701 PMCID: PMC5390833 DOI: 10.1002/brb3.648] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 12/20/2016] [Accepted: 12/22/2016] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Discovery of specific antibodies against astrocytic water channel aquaporin-4 (AQP4), which is produced by plasma cells, in the serum of neuromyelitis optica (NMO) confirmed the pathogenic role of B cells in NMO. C-X-C motif ligand 13 (CXCL13) and B-cell-activating factor (BAFF) are two crucial factors for antibody production. Relevant studies have focused on the acute phase of NMO. However, CXCL13 and BAFF levels during remission, remain to be elucidated. OBJECTIVE To evaluate serum levels of CXCL13 and BAFF in NMO and multiple sclerosis (MS) patients during remission and explore their correlation with immunosuppressive agents and clinical features in NMO. METHODS Serum CXCL13 and BAFF were measured by enzyme-linked immunosorbent assay (ELISA) in NMO patients, MS patients, and controls. RESULTS Serum CXCL13 levels of NMO patients (n = 24) were significantly higher than those of controls (n = 22) (p = .001), but CXCL13 levels of MS patients (n = 20) and controls (n = 22) did not differ significantly (p = .279). Although the three groups showed no differences in serum BAFF levels, serum BAFF levels of NMO patients without immunosuppressive treatment (n = 8) were significantly elevated compared with those of NMO patients with immunosuppressive therapy (n = 16) (p = .003) and controls (n = 22) (p = .024). In NMO patients, CXCL13 levels were correlated with onset age (p = .026) and duration to the last relapse (p = .003). CONCLUSION During remission, serum CXCL13 and BAFF levels have not decreased to normal in NMO patients, and B-cell-related autoimmune response persists. Immunosuppressive therapy decreased serum BAFF levels, but did not affect CXCL13 expression.
Collapse
Affiliation(s)
- Su Wang
- Department of Traditional Chinese Medicine Beijing Tiantan Hospital Capital Medical University Beijing China.,Department of Oncology Qingdao Hiser Medical Group Qingdao China
| | - Tao Yang
- Department of Traditional Chinese Medicine Beijing Tiantan Hospital Capital Medical University Beijing China
| | - Jianglong Wan
- Department of Traditional Chinese Medicine Beijing Tiantan Hospital Capital Medical University Beijing China.,Department of Traditional Chinese Medicine Miyun Xitiangezhuang Town Community Health Service Center Beijing China
| | - Yongchao Zhang
- Department of Traumatic Orthopedics Qingdao Hiser Medical Group Qingdao China
| | - Yongping Fan
- Department of Traditional Chinese Medicine Beijing Tiantan Hospital Capital Medical University Beijing China
| |
Collapse
|
44
|
Etemadifar M, Salari M, Mirmosayyeb O, Serati M, Nikkhah R, Askari M, Fayyazi E. Efficacy and safety of rituximab in neuromyelitis optica: Review of evidence. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2017; 22:18. [PMID: 28458709 PMCID: PMC5367207 DOI: 10.4103/1735-1995.200275] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 10/01/2016] [Accepted: 11/16/2016] [Indexed: 12/22/2022]
Abstract
Neuromyelitis optica (NMO) is an autoimmune inflammatory disease of the central nervous system with preferential involvement in the optic nerve and spinal cord with a widespread spectrum of clinical features; multiple therapeutic agents have been used with different results. Recent evidence points to B-cell-mediated humoral immunity in the pathogenesis of NMO. Rituximab targets the CD20 antigen on B-cells. Treatment leads to profound B-cell depletion, principally over an antibody-dependent cell cytotoxicity mechanism. The aim of our study was to review clinical trials to elucidate the impact of rituximab on the relapse rate, Expanded Disability Status Scale (EDSS), and progression of disability in NMO. We performed a comprehensive review of all studies that evaluated clinical and paraclinical effects of rituximab on NMO. MEDLINE-PubMed, Web of Sciences, EMBASE, and Cochrane databases up to June 2016 included in our searches. In addition, reference lists from articles identified by search as well as a key review article to identify additional articles included in the study. Rituximab targets the CD20 antigen on B-cells and decreases attack frequency and severity in patients with NMO; however, it does not remove attacks, even when modifying treatment to achieve B-cell depletion. Most of the investigations revealed that EDSS significantly in all patients with rituximab treatment will be decreased after treatment with rituximab. No new or enlarged lesions or pathological gadolinium enhancement was observed in serial brain and spinal cord magnetic resonance imaging, except for those observed concomitantly with clinical relapses and the median length of spinal cord lesions was significantly reduced after therapy. Rituximab targets the CD20 antigen and decreases attack frequency and severity in patients with NMO.
Collapse
Affiliation(s)
- Masoud Etemadifar
- Department of Neurology, Isfahan University of Medical Sciences, Isfahan, Iran.,Isfahan Research Committee of Multiple Sclerosis, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mehri Salari
- Department of Neurology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Omid Mirmosayyeb
- Isfahan Research Committee of Multiple Sclerosis, Isfahan University of Medical Sciences, Isfahan, Iran.,Medical Student Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mehdi Serati
- Isfahan Research Committee of Multiple Sclerosis, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Roham Nikkhah
- Isfahan Research Committee of Multiple Sclerosis, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mozhde Askari
- Isfahan Research Committee of Multiple Sclerosis, Isfahan University of Medical Sciences, Isfahan, Iran.,Medical Student Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Emad Fayyazi
- Isfahan Research Committee of Multiple Sclerosis, Isfahan University of Medical Sciences, Isfahan, Iran
| |
Collapse
|
45
|
Abstract
Rituximab, a monoclonal antibody targeting the B cell marker CD20, was initially approved in 1997 by the United States Food and Drug Administration (FDA) for the treatment of non-Hodgkin lymphoma. Since that time, rituximab has been FDA-approved for rheumatoid arthritis and vasculitides, such as granulomatosis with polyangiitis and microscopic polyangiitis. Additionally, rituximab has been used off-label in the treatment of numerous other autoimmune diseases, with notable success in pemphigus, an autoantibody-mediated skin blistering disease. The efficacy of rituximab therapy in pemphigus has spurred interest in its potential to treat other autoantibody-mediated diseases. This review summarizes the efficacy of rituximab in pemphigus and examines its off-label use in other select autoantibody-mediated diseases.
Collapse
Affiliation(s)
- Nina A Ran
- Department of Dermatology, University of Pennsylvania, 1009 Biomedical Research Building, 421 Curie Boulevard, PA, USA
| | - Aimee S Payne
- Department of Dermatology, University of Pennsylvania, 1009 Biomedical Research Building, 421 Curie Boulevard, PA, USA
| |
Collapse
|
46
|
Kim SH, Hyun JW, Joung A, Park EY, Joo J, Kim HJ. Predictors of response to first-line immunosuppressive therapy in neuromyelitis optica spectrum disorders. Mult Scler 2017; 23:1902-1908. [DOI: 10.1177/1352458516687403] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Background: Azathioprine (AZA) and mycophenolate mofetil (MMF) are the most commonly used first-line therapies for patients with neuromyelitis optica spectrum disorders (NMOSD). However, some patients experience a relapse following AZA or MMF treatment. Objectives: To identify factors that predict a response to AZA or MMF in NMOSD. Methods: We retrospectively evaluated medical records from 116 patients who were initially treated with AZA or MMF for at least 6 months. Poor response was defined as ⩾2 relapses or ⩾1 severe relapse. Results: Among the 116 patients, 40 (34%) were classified as poor responders. Logistic regression analyses revealed that a poor response was independently associated with a pre-treatment history of a severe attack ( p < 0.001) and a younger age at disease onset ( p = 0.022). Among the 40 patients with a poor response, 29 (73%) switched to rituximab, and only 3 (10%) had a poor response to rituximab. Conclusion: Patients with a pre-treatment history of a severe attack and a younger age of onset exhibited an increased risk of a poor response to AZA or MMF therapy. Identifying patients who are unlikely to respond to AZA or MMF therapy may allow for treatment with more potent therapies that improve treatment outcomes.
Collapse
Affiliation(s)
- Su-Hyun Kim
- Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang-si, Korea
| | - Jae-Won Hyun
- Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang-si, Korea
| | - AeRan Joung
- Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang-si, Korea
| | - Eun Young Park
- Biometric Research Branch, Research Institute and Hospital of National Cancer Center, Goyang-si, Korea
| | - Jungnam Joo
- Biometric Research Branch, Research Institute and Hospital of National Cancer Center, Goyang-si, Korea
| | - Ho Jin Kim
- Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang-si, Korea
| |
Collapse
|
47
|
Cohen M, Romero G, Bas J, Ticchioni M, Rosenthal M, Lacroix R, Brunet C, Rico A, Pelletier J, Audoin B, Lebrun C. Monitoring CD27+ memory B-cells in neuromyelitis optica spectrum disorders patients treated with rituximab: Results from a bicentric study. J Neurol Sci 2017; 373:335-338. [PMID: 28131216 DOI: 10.1016/j.jns.2017.01.025] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 12/15/2016] [Accepted: 01/06/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Rituximab (RTX) is increasingly used in the treatment of neuromyelitis optica spectrum disorder (NMO-SD). Administration regimen is not consensual as there is no reliable biomarker of RTX efficacy. In most cases, after induction, RTX is administered systematically every 6months. OBJECTIVE To assess efficacy and safety of a maintenance regimen based on CD19+ CD27+ memory B-cell (mBc) detection. METHODS We conducted a study in two French centers, including patients with NMO-SD who received an induction therapy with RTX. We compared the number of administered infusions, relapses and EDSS depending on two maintenance schemes (S1: administration of 1g RTX infusion every 6months or S2: a scheme based on regular mBc detection. 1g RTX was administered if mBc was >0.05%) RESULTS: 40 patients were included (mean age: 40.2years, F/M sex ratio: 5/1). Aquaporin-4 antibodies were positive in 75% patients. Under S1 regimen, all patients received 2 infusions per year, whereas under S2, they received 1.62 infusion per year. The mean interval between infusions under S2 was 7.4months, without decrease of clinical efficacy. CONCLUSION In our study, mBc-based administration of RTX allowed personalizing treatment administration and in several cases to lower the cumulative dose without loss of efficacy.
Collapse
Affiliation(s)
- M Cohen
- Department of Neurology, Hôpital Pasteur 2, Nice, France.
| | - G Romero
- Department of Neurology, Hôpital Pasteur 2, Nice, France
| | - J Bas
- Aix Marseille Univ, APHM, Hôpital de la Timone, Pôle de Neurosciences Cliniques, Service de Neurologie, 13005 Marseille, France
| | - M Ticchioni
- Department of Immunology, Hôpital l'Archet, Nice, France
| | - M Rosenthal
- Department of Immunology, Hôpital l'Archet, Nice, France
| | - R Lacroix
- Hematology and Vascular Biology Department, CHU La Conception, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - C Brunet
- Hematology and Vascular Biology Department, CHU La Conception, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - A Rico
- Aix Marseille Univ, APHM, Hôpital de la Timone, Pôle de Neurosciences Cliniques, Service de Neurologie, 13005 Marseille, France
| | - J Pelletier
- Aix Marseille Univ, APHM, Hôpital de la Timone, Pôle de Neurosciences Cliniques, Service de Neurologie, 13005 Marseille, France
| | - B Audoin
- Aix Marseille Univ, APHM, Hôpital de la Timone, Pôle de Neurosciences Cliniques, Service de Neurologie, 13005 Marseille, France
| | - C Lebrun
- Department of Neurology, Hôpital Pasteur 2, Nice, France
| |
Collapse
|
48
|
Abstract
Rituximab is a monoclonal antibody that depletes B cells from the circulation. It was originally used to treat lymphoma but is increasingly used for the treatment of autoimmune diseases. Rituximab was found to be effective in randomised controlled trials for rheumatoid arthritis, granulomatosis with polyangiitis and other antineutrophil cytoplasmic antibody-associated vasculitides. However, evidence of efficacy is very limited for many other autoimmune conditions. Before starting rituximab, it is important to check the patient's baseline immunoglobulins and immunisation status. Patients should also be screened for latent infections and other contraindications.
Collapse
|
49
|
Annovazzi P, Capobianco M, Moiola L, Patti F, Frau J, Uccelli A, Centonze D, Perini P, Tortorella C, Prosperini L, Lus G, Fuiani A, Falcini M, Martinelli V, Comi G, Ghezzi A. Rituximab in the treatment of Neuromyelitis optica: a multicentre Italian observational study. J Neurol 2016; 263:1727-35. [PMID: 27286847 DOI: 10.1007/s00415-016-8188-y] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 05/30/2016] [Accepted: 05/31/2016] [Indexed: 01/10/2023]
Abstract
Rituximab (RTX) efficacy in NMO is suggested by several case series. No consensus exists on optimal dosing strategies. At present the treatment schedules more frequently used are 375 mg/m2/week iv for 4 weeks (RTX-A) and 1000 mg iv twice, 2 weeks apart (RTX-B). Aim of this study is to confirm RTX efficacy and safety in the treatment of NMO and to evaluate whether a most favourable dosage regimen exists. Data on RTX-treated NMO patients were collected from 13 Italian Hospitals. 73 patients (64 F), were enlisted. RTX-A was administered in 42/73 patients, RTX-B in 31/73. Median follow-up was 27 months (range 7-106). Mean relapse rate in the previous year before RTX start was 2.2 ± 1.3 for RTX-A and 2.3 ± 1.2 for RTX-B. ARR in the first year of treatment was 0.8 ± 0.9 for RTX-A and 0.2 ± 0.4 for RTX-B, in the second year of treatment was 0.9 ± 1.5 for RTX-A and 0.4 ± 0.8 for RTX-B patients (p = 0.001 for the first year, ns (0.09) for the second year). RTX-B was more effective in delaying the occurrence of a relapse (HR 2.2 (95 % IC 1.08-4.53) p = 0.02). Adverse events were described in 19/73 patients (mainly urinary tract and respiratory infections, and infusion reactions). Two deaths were reported in severely disabled patients. Though with the limitations of an observational study, our data support RTX efficacy in NMO and suggest that high dose pulses might be more effective than a more fractioned dose.
Collapse
Affiliation(s)
- Pietro Annovazzi
- Multiple Sclerosis Study Center, ASST Valle Olona, PO di Gallarate (VA), Italy.
| | - M Capobianco
- Regional MS Center, University Hospital S. Luigi Gonzaga, Orbassano (TO), Italy
| | - L Moiola
- Department of Neurology, Scientific Institute H. San Raffaele, University Vita-Salute, Milan, Italy
| | - F Patti
- Multiple Sclerosis Center, University of Catania, Catania, Italy
| | - J Frau
- Multiple Sclerosis Center, University of Catania, Catania, Italy
| | - A Uccelli
- Department of Neurosciences Ophtalmology and Genetics, University of Genoa, Genoa, Italy
| | - D Centonze
- Department of Neurology I and neurorehabilitation, IRCCS Neuromed, Pozzilli (IS), Italy
- Department of Systems Medicine, University of Tor Vergata, Rome, Italy
| | - P Perini
- Department of Neurology, AO University of Padova, Padua, Italy
| | - C Tortorella
- Departments of Neurological and Psychiatric Sciences, University of Bari, Bari, Italy
| | - L Prosperini
- Department of Neurology and Psychiatry, Sapienza University, Rome, Italy
| | - G Lus
- Department of Neurological Sciences, School of Medicine, Second University of Naples, Policlinico Federico II, Naples, Italy
| | - A Fuiani
- Department of Neurosciences, Multiple Sclerosis Unit, General Hospital, "OORR", Foggia, Italy
| | - M Falcini
- Multiple Sclerosis Center, Ospedale Misericordia e Dolce, Prato, Italy
| | - V Martinelli
- Department of Neurology, Scientific Institute H. San Raffaele, University Vita-Salute, Milan, Italy
| | - G Comi
- Multiple Sclerosis Study Center, ASST Valle Olona, PO di Gallarate (VA), Italy
- Department of Neurology, Scientific Institute H. San Raffaele, University Vita-Salute, Milan, Italy
| | - A Ghezzi
- Multiple Sclerosis Study Center, ASST Valle Olona, PO di Gallarate (VA), Italy
| |
Collapse
|