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August 20, 2013; 81 (8) Article

Responsiveness to reduced dosage of rituximab in Chinese patients with neuromyelitis optica

Chun-Sheng Yang, Li Yang, Ting Li, Da-Qi Zhang, Wei-Na Jin, Min-Shu Li, Ning Su, Nannan Zhangning, Qiang Liu, Zong-Hong Shao, Chunshui Yu, Fu-Dong Shi
First published July 24, 2013, DOI: https://doi.org/10.1212/WNL.0b013e3182a1aac7
Chun-Sheng Yang
From the Departments of Neurology (C.-S.Y., L.Y., T.L., D.-Q.Z., W.-N.J., M.-S.L., N.S., Q.L., F.-D.S.), Hematology (Z.-H.S.), and Radiology (N.Z., C.Y.), and Tianjin Neurological Institute (C.-S.Y., L.Y., T.L., D.-Q.Z., W.-N.J., M.-S.L., N.S., Q.L., F.-D.S.), Tianjin Medical University General Hospital, China; and Department of Neurology (N.S., Q.L., F.-D.S.), Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ.
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Li Yang
From the Departments of Neurology (C.-S.Y., L.Y., T.L., D.-Q.Z., W.-N.J., M.-S.L., N.S., Q.L., F.-D.S.), Hematology (Z.-H.S.), and Radiology (N.Z., C.Y.), and Tianjin Neurological Institute (C.-S.Y., L.Y., T.L., D.-Q.Z., W.-N.J., M.-S.L., N.S., Q.L., F.-D.S.), Tianjin Medical University General Hospital, China; and Department of Neurology (N.S., Q.L., F.-D.S.), Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ.
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Ting Li
From the Departments of Neurology (C.-S.Y., L.Y., T.L., D.-Q.Z., W.-N.J., M.-S.L., N.S., Q.L., F.-D.S.), Hematology (Z.-H.S.), and Radiology (N.Z., C.Y.), and Tianjin Neurological Institute (C.-S.Y., L.Y., T.L., D.-Q.Z., W.-N.J., M.-S.L., N.S., Q.L., F.-D.S.), Tianjin Medical University General Hospital, China; and Department of Neurology (N.S., Q.L., F.-D.S.), Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ.
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Da-Qi Zhang
From the Departments of Neurology (C.-S.Y., L.Y., T.L., D.-Q.Z., W.-N.J., M.-S.L., N.S., Q.L., F.-D.S.), Hematology (Z.-H.S.), and Radiology (N.Z., C.Y.), and Tianjin Neurological Institute (C.-S.Y., L.Y., T.L., D.-Q.Z., W.-N.J., M.-S.L., N.S., Q.L., F.-D.S.), Tianjin Medical University General Hospital, China; and Department of Neurology (N.S., Q.L., F.-D.S.), Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ.
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Wei-Na Jin
From the Departments of Neurology (C.-S.Y., L.Y., T.L., D.-Q.Z., W.-N.J., M.-S.L., N.S., Q.L., F.-D.S.), Hematology (Z.-H.S.), and Radiology (N.Z., C.Y.), and Tianjin Neurological Institute (C.-S.Y., L.Y., T.L., D.-Q.Z., W.-N.J., M.-S.L., N.S., Q.L., F.-D.S.), Tianjin Medical University General Hospital, China; and Department of Neurology (N.S., Q.L., F.-D.S.), Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ.
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Min-Shu Li
From the Departments of Neurology (C.-S.Y., L.Y., T.L., D.-Q.Z., W.-N.J., M.-S.L., N.S., Q.L., F.-D.S.), Hematology (Z.-H.S.), and Radiology (N.Z., C.Y.), and Tianjin Neurological Institute (C.-S.Y., L.Y., T.L., D.-Q.Z., W.-N.J., M.-S.L., N.S., Q.L., F.-D.S.), Tianjin Medical University General Hospital, China; and Department of Neurology (N.S., Q.L., F.-D.S.), Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ.
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Ning Su
From the Departments of Neurology (C.-S.Y., L.Y., T.L., D.-Q.Z., W.-N.J., M.-S.L., N.S., Q.L., F.-D.S.), Hematology (Z.-H.S.), and Radiology (N.Z., C.Y.), and Tianjin Neurological Institute (C.-S.Y., L.Y., T.L., D.-Q.Z., W.-N.J., M.-S.L., N.S., Q.L., F.-D.S.), Tianjin Medical University General Hospital, China; and Department of Neurology (N.S., Q.L., F.-D.S.), Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ.
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Nannan Zhangning
From the Departments of Neurology (C.-S.Y., L.Y., T.L., D.-Q.Z., W.-N.J., M.-S.L., N.S., Q.L., F.-D.S.), Hematology (Z.-H.S.), and Radiology (N.Z., C.Y.), and Tianjin Neurological Institute (C.-S.Y., L.Y., T.L., D.-Q.Z., W.-N.J., M.-S.L., N.S., Q.L., F.-D.S.), Tianjin Medical University General Hospital, China; and Department of Neurology (N.S., Q.L., F.-D.S.), Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ.
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Qiang Liu
From the Departments of Neurology (C.-S.Y., L.Y., T.L., D.-Q.Z., W.-N.J., M.-S.L., N.S., Q.L., F.-D.S.), Hematology (Z.-H.S.), and Radiology (N.Z., C.Y.), and Tianjin Neurological Institute (C.-S.Y., L.Y., T.L., D.-Q.Z., W.-N.J., M.-S.L., N.S., Q.L., F.-D.S.), Tianjin Medical University General Hospital, China; and Department of Neurology (N.S., Q.L., F.-D.S.), Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ.
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Zong-Hong Shao
From the Departments of Neurology (C.-S.Y., L.Y., T.L., D.-Q.Z., W.-N.J., M.-S.L., N.S., Q.L., F.-D.S.), Hematology (Z.-H.S.), and Radiology (N.Z., C.Y.), and Tianjin Neurological Institute (C.-S.Y., L.Y., T.L., D.-Q.Z., W.-N.J., M.-S.L., N.S., Q.L., F.-D.S.), Tianjin Medical University General Hospital, China; and Department of Neurology (N.S., Q.L., F.-D.S.), Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ.
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Chunshui Yu
From the Departments of Neurology (C.-S.Y., L.Y., T.L., D.-Q.Z., W.-N.J., M.-S.L., N.S., Q.L., F.-D.S.), Hematology (Z.-H.S.), and Radiology (N.Z., C.Y.), and Tianjin Neurological Institute (C.-S.Y., L.Y., T.L., D.-Q.Z., W.-N.J., M.-S.L., N.S., Q.L., F.-D.S.), Tianjin Medical University General Hospital, China; and Department of Neurology (N.S., Q.L., F.-D.S.), Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ.
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Fu-Dong Shi
From the Departments of Neurology (C.-S.Y., L.Y., T.L., D.-Q.Z., W.-N.J., M.-S.L., N.S., Q.L., F.-D.S.), Hematology (Z.-H.S.), and Radiology (N.Z., C.Y.), and Tianjin Neurological Institute (C.-S.Y., L.Y., T.L., D.-Q.Z., W.-N.J., M.-S.L., N.S., Q.L., F.-D.S.), Tianjin Medical University General Hospital, China; and Department of Neurology (N.S., Q.L., F.-D.S.), Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ.
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Full PDF
Citation
Responsiveness to reduced dosage of rituximab in Chinese patients with neuromyelitis optica
Chun-Sheng Yang, Li Yang, Ting Li, Da-Qi Zhang, Wei-Na Jin, Min-Shu Li, Ning Su, Nannan Zhangning, Qiang Liu, Zong-Hong Shao, Chunshui Yu, Fu-Dong Shi
Neurology Aug 2013, 81 (8) 710-713; DOI: 10.1212/WNL.0b013e3182a1aac7

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Abstract

Objective: To determine the effect of a lower dose of rituximab in depleting B lymphocytes, maintaining low B-cell counts, and relapse in patients with neuromyelitis optica (NMO) and NMO spectrum disorders.

Methods: We treated 5 Chinese patients with deteriorating NMO and NMO spectrum disorders with a 100-mg IV infusion of rituximab once a week for 3 consecutive weeks, followed by additional infusion of the same dosage depending on circulating B-cell repopulation.

Results: This reduced dosage of rituximab was sufficient to deplete B cells and maintain low B-cell counts. None of the treated patients experienced relapse, and all patients exhibited stabilized or improved neurologic function during the 1-year follow-up period. MRI revealed the absence of new lesions, no enhancement in spinal cord and brain, a significant shrinkage of spinal cord segments, and a reduction/disappearance of previous brain lesions.

Conclusion: A lower dosage of rituximab may be sufficient in depleting B cells, maintaining low B-cell counts, and preventing disease progression in Chinese patients with NMO.

GLOSSARY

EDSS=
Expanded Disability Status Scale;
MS=
multiple sclerosis;
NMO=
neuromyelitis optica

Footnotes

  • Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • Received January 10, 2013.
  • Accepted in final form May 8, 2013.
  • © 2013 American Academy of Neurology
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Disputes & Debates: Rapid online correspondence

  • Could reduced dosage really work?
    • Jun Xu, Director, Jiangsu Province Geriatric Hospitalneurojun@126.com
    • Jun Xu, Nanjing, China; Xin-xin Cheng, Nanjing, China; Jia-ren Xu , Nanjing, China
    Submitted September 13, 2013
  • Reply to: Uncertainly regarding the clinical efficacy and B cell depletion of low-dose rituximab therapy in neuromyelitis optica
    • Fu-Dong Shi, Professor of neurology, Department of Neurology and Tianjin Neurological Institute, Tianjin Medical University General Hospifshi@tijmu.edu.cn
    • Chun-Sheng Yang, Tianjin, China; Li Yang, Tianjin, China; Ting Li, Tianjin, China; Wei-Na Jin, Tianjin, China; Fu-Dong Shi, Tianjin, China & Phoenix, AZ, USA
    Submitted September 13, 2013
  • Uncertainty regarding the clinical efficacy and B cell depletion of low-dose rituximab therapy in neuromyelitis optica
    • Ho Jin Kim, MD, PhD, Department of Neurology, Research Institute and Hospital of National Cancer Center, Koreahojinkim@ncc.re.kr
    • Su-Hyun Kim, MD, Goyang-si, Gyeonggi-do, Korea
    Submitted August 16, 2013
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