RT Journal Article
SR Electronic
T1 Long-term follow-up of patients with neuromyelitis optica after repeated therapy with rituximab
JF Neurology
JO Neurology
FD Lippincott Williams & Wilkins
SP 1310
OP 1315
DO 10.1212/WNL.0b013e3182152881
VO 76
IS 15
A1 H.L. Pellkofer
A1 M. Krumbholz
A1 A. Berthele
A1 B. Hemmer
A1 L.A. Gerdes
A1 J. Havla
A1 R. Bittner
A1 M. Canis
A1 E. Meinl
A1 R. Hohlfeld
A1 T. Kuempfel
YR 2011
UL http://n.neurology.org/content/76/15/1310.abstract
AB Background: Neuromyelitis optica (NMO) is a severe autoimmune disease targeting optic nerves and spinal cord. The monoclonal anti-CD20 B-cell antibody rituximab is an emerging therapeutic option in NMO. However, neither long-term efficacy or safety of rituximab, nor the correlation between B-cell counts, B-cell fostering cytokines, aquaporin-4 antibodies (AQP4-ab), and disease activity in NMO, have been investigated prospectively. Methods: We performed a prospective long-term cohort study of 10 patients with NMO who were treated up to 5 times with rituximab as a second-line therapy. Clinical examinations, B-cell counts, and serum concentrations of BAFF (B-cell activating factor of the TNF family; also called TNFSF13b), APRIL (a proliferation-inducing ligand; also called TNFSF13), AQP4-ab, and immunoglobulin levels were measured every 3 months. Results: Repeated treatment with rituximab led to sustained clinical stabilization in most patients with NMO. Disease activity correlated with B-cell depletion, but not clearly with AQP4-ab or levels of APRIL. BAFF levels increased after application of rituximab and indicated persisting efficacy of the drug but did not correlate with disease activity. Overall, rituximab was well-tolerated even after up to 5 consecutive treatment courses; however, we observed several severe adverse reactions. Conclusion: Our data indicate that long-term therapy with rituximab is effective in NMO as a second-line therapy and has an acceptable safety profile. Retreatment with rituximab should be applied before reappearance of circulating B cells. Classification of evidence: This study provides Class IV evidence that repeated doses of rituximab result in stabilization in most patients.