Open AccessThe efficacy of rituximab in patients with neuromyelitis optica spectrum disorder: A real‐world study from Turkey
Author(s) -
Uzunköprü Cihat,
Tütüncü Melih,
Gündüz Tuncay,
Gümüş Haluk,
Şen Sedat,
Demir Serkan,
Çınar Bilge Piri,
Türe Hatice Sabiha,
Uygunoğlu Uğur,
Toğrol Rıfat Erdem,
Terzi Murat,
Kürtüncü Murat,
Özakbaş Serkan,
Tütüncü Mesude,
Beckmann Yeşim,
Siva Aksel
Publication year - 2021
Publication title -
international journal of clinical practice
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.756
H-Index - 98
eISSN - 1742-1241
pISSN - 1368-5031
DOI - 10.1111/ijcp.14158
Subject(s) - medicine , rituximab , neuromyelitis optica , expanded disability status scale , myelin oligodendrocyte glycoprotein , spectrum disorder , cohort , gastroenterology , multiple sclerosis , retrospective cohort study , immunology , central nervous system , myelin , lymphoma , psychiatry
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.