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Journal of Neurology

, Volume 262, Issue 10, pp 2329–2335 | Cite as

Rituximab as first-line therapy in neuromyelitis optica: efficiency and tolerability

  • Hélène ZéphirEmail author
  • Raphaël Bernard-Valnet
  • Christine Lebrun
  • Olivier Outteryck
  • Bertrand Audoin
  • Bertrand Bourre
  • Sophie Pittion
  • Sandrine Wiertlewski
  • Jean Christophe Ouallet
  • Jean-Philippe Neau
  • Jonathan Ciron
  • Pierre Clavelou
  • Romain Marignier
  • David Brassat
Original Communication

Abstract

Neuromyelitis optica (NMO) is a life-threatening disease without any validated treatment strategy. Recent retrospective studies suggested the efficacy of B cell depletion without any distinction between first-line or rescue therapy. To assess whether rituximab as first-line therapy in NMO could efficiently control the occurrence of relapses. A retrospective analysis of NMO patients from NOMADMUS network found 32 patients receiving rituximab as first-line therapy. Main measures were number of relapse-free patients, changes in the annualized relapse rate (ARR), and changes in the EDSS. Tolerance was reported. At baseline, NMO patients were 45 ± 12.1 years old, with a sex ratio of 5.4, and 87.5 % of them had AQP4 antibodies. The median disease duration was 6.5 months (1–410), the mean EDSS was 5.8 ± 2.4 and the mean ARR was 3.8 ± 4.3. After rituximab with a mean follow-up of 28.7 ± 21 months, twenty-seven patients (84.3 %) were relapse free. Patients presented a 97 % decrease of ARR (p = 0.00001). EDSS decreased significantly to 3.9 ± 2.6 (p = 0.01). No relevant side effect was noted. New retrospective data are presented on RTX use in NMOSD. When used as first-line therapy RTX is highly effective and well tolerated.

Keywords

Neuromyelitis optica Rituximab Immunosuppression Aquaporin 4 Relapse free B Cell depletion 

Notes

Acknowledgments

SFSEP: Société Francophone de la Sclérose en Plaques. NOMADMUS: groupe de travail sur la neuromyélite optique aiguë de Device. The authors are grateful to the members of the NOMADMUS group: Bruno Brochet, Philippe Cabre, Jean-Philippe Camdessanche, William Camu, Olivier Casez, Giovanni Castelnovo, Michel Clanet, Nicolas Collongues, François Cotton, Alain Creange, Gilles Defer, Jérôme de Seze, Marc Debouverie, Gilles Edan, Olivier Gout, Guillemette Jousserand, Philippe Kirschen, Pierre Labauge, David Laplaud, Thibault Moreau, Caroline Papeix, Jean Pelletier, Bruno Stankoff, Ayman Tourbah, Patrick Vermersch, Sandra Vukusic, and to the members of SFSEP group: Latif Al Kedhr, Olivier Anne, Eric Berger, Bruno Brochet, Philippe Cabre, Jean-Philippe Camdessanche, Olivier Casez, Marc Coustans, Alain Creange, Gilles Defer, Jérôme de Seze, Marc Debouverie, Nathalie Derache, Dominique Dive, Gilles Edan, Agnes Fromont, Riadh Gouider, Jérôme Grimaud, Arnaud Kwiatkowski, Olivier Heinzlef, Pierre Labauge, Emmanuelle le Page, Thibault Moreau, Caroline Papeix, Jean Pelletier, Pierrette Seeldrayers, Ilham Slassi Sennou, Bruno Stankoff, Ayman Tourbah, Frederic Thaite, Eric Thouvenot, Patrick Vermersch.

Compliance with ethical standards

Conflicts of interest

None of authors have conflict of interest with this study.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Hélène Zéphir
    • 1
    Email author
  • Raphaël Bernard-Valnet
    • 2
  • Christine Lebrun
    • 3
  • Olivier Outteryck
    • 1
  • Bertrand Audoin
    • 4
  • Bertrand Bourre
    • 5
  • Sophie Pittion
    • 6
  • Sandrine Wiertlewski
    • 7
  • Jean Christophe Ouallet
    • 8
  • Jean-Philippe Neau
    • 9
  • Jonathan Ciron
    • 9
  • Pierre Clavelou
    • 10
  • Romain Marignier
    • 11
  • David Brassat
    • 2
  1. 1.Clinique Neurologique, Hôpital Roger SalengroCHRU de Lille, Université de LilleLilleFrance
  2. 2.Pole des NeurosciencesCHU Toulouse and UMR 1043, Université de Toulouse IIIToulouseFrance
  3. 3.Service de NeurologieHôpital Pasteur, CHU de NiceNiceFrance
  4. 4.Service de NeurologieHôpital Universitaire de la TimoneMarseilleFrance
  5. 5.Service de NeurologieCHU de RouenRouenFrance
  6. 6.Service de NeurologieHôpital CentralNancyFrance
  7. 7.Service de NeurologieCHU de NantesNantesFrance
  8. 8.Service de NeurologieCHU de BordeauxBordeauxFrance
  9. 9.Service de NeurologieCHU de PoitiersPoitiersFrance
  10. 10.Service de NeurologieCHU de Clermont-FerrandClermont-FerrandFrance
  11. 11.Service de NeurologieHôpital Wertheimer, Hospices Civils de LyonBronFrance

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