Early rituximab treatment reduces long-term disability in aquaporin-4 antibody-positive neuromyelitis optica spectrum

• Published in: Journal of neurology, neurosurgery and psychiatry Vol. 94; no. 10; pp. 800 - 805
• Main Authors: Park, Su Yeon, Kwon, Young Nam, Kim, Sunyoung, Kim, Seung-Hyun, Kim, Jong Kuk, Kim, Jun-Soon, Nam, Tai-Seung, Min, Young Gi, Park, Kyung Seok, Park, Jin-Sung, Seok, Jin Myoung, Sung, Jung-Joon, Sohn, Eunhee, Shin, Kyong Jin, Shin, Jin-Hong, Shin, Ha Young, Oh, Seong-il, Oh, Jeeyoung, Yoon, Byeol-A, Lee, Sanggon, Lee, Jong-Mok, Lee, Hye Lim, Choi, Kyomin, Huh, So-Young, Jang, Myoung-jin, Min, Ju-Hong, Kim, Byoung Joon, Kim, Sung-Min
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group Ltd 01.10.2023; BMJ Publishing Group LTD
• Subjects: Apheresis; Aquaporins; Autoimmune diseases; Body mass index; FDA approval; Females; Immunosuppressive agents; Immunotherapy; Infections; Interferon; Medical prognosis; Monoclonal antibodies; Multiple sclerosis; NEUROIMMUNOLOGY; Patients; Prevention; Regression analysis; Spinal cord; Steroids; Visual acuity; NEUROIMMUNOLOGY
• ISSN: 0022-3050; 1468-330X; 1468-330X
• DOI: 10.1136/jnnp-2022-330714

BackgroundNeuromyelitis optica spectrum disorder (NMOSD) causes relapsing inflammatory attacks in the central nervous system, leading to disability. As rituximab, a B-lymphocyte-depleting monoclonal antibody, is an effective in preventing NMOSD relapses, we hypothesised that earlier initiation of rituximab can also reduce long-term disability of patients with NMOSD.MethodsThis multicentre retrospective study involving 19 South Korean referral centres included patients with NMOSD with aquaporin-4 antibodies receiving rituximab treatment. Factors associated with the long-term Expanded Disability Status Scale (EDSS) were assessed using multivariable regression analysis.ResultsIn total, 145 patients with rituximab treatment (mean age of onset, 39.5 years; 88.3% female; 98.6% on immunosuppressants/oral steroids before rituximab treatment; mean disease duration of 121 months) were included. Multivariable analysis revealed that the EDSS at the last follow-up was associated with time to rituximab initiation (interval from first symptom onset to initiation of rituximab treatment). EDSS at the last follow-up was also associated with maximum EDSS before rituximab treatment. In subgroup analysis, the time to initiation of rituximab was associated with EDSS at last follow-up in patients aged less than 50 years, female and those with a maximum EDSS score ≥6 before rituximab treatment.ConclusionsEarlier initiation of rituximab treatment may prevent long-term disability worsening in patients with NMOSD, especially among those with early to middle-age onset, female sex and severe attacks.