Journal of Neurology

, Volume 265, Issue 4, pp 917–925 | Cite as

Treatment of neuromyelitis optica with rituximab: a 2-year prospective multicenter study

  • Philippe Cabre
  • M. Mejdoubi
  • S. Jeannin
  • H. Merle
  • Y. Plumelle
  • G. Cavillon
  • D. Smadja
  • R. Marignier
  • On behalf of Francophone Society of Multiple Sclerosis and OFSEP investigators
Original Communication

Abstract

Objective

Neuromyelitis optica (NMO) is a very severe autoimmune disorder of the central nervous system. It affects young subjects and has a poor prognosis both on a functional and vital level. Therefore, it is imperative to reduce the frequency of relapses. The purpose of this study was to evaluate the clinical and neuroradiological effectiveness of rituximab (RTX) on active forms of NMO.

Methods

We conducted a 2-year open prospective multicenter study that included 32 patients treated with RTX at a dose of 375 mg/m2/week for 1 month. When the number of circulating CD19+ B cells reached 1%, a maintenance therapy was started, consisting of two infusions of 1 g of RTX, administered at a 15-day interval. The primary objective was to reduce the annual relapse rate (ARR), in comparison to that observed in the 2 years before treatment onset.

Results

Rituximab administration reduced the ARR from 1.34 to 0.56 (p = 0.0005). The average Expanded Disability Status Scale (EDSS) score significantly improved by 1.1 point, from 5.9 (2–9) to 4.8 (0–9) after 2 years (p = 0.03). Anti-aquaporin-4 antibodies’ level predicted treatment failure (p = 0.03). Frequency of Gad+ lesions in spinal cord decreased from 23.3 to 14.2%. RTX treatment did not prevent the death of three patients (treatment failure in two patients and acute myeloid leukemia in a patient previously treated with mitoxantrone).

Conclusion

Rituximab is clinically effective in active forms of NMO, although few patients are resistant to the treatment.

Keywords

Neuromyelitis optica Rituximab Treatment Magnetic resonance imaging 

Notes

Acknowledgements

The authors acknowledge D. Laplaud MD, PhD from CHRU Nantes (France), R. Deschamps MD and O. Gout MD from Rothschild Foundation (France), and J. de Seze MD, PhD, from CHRU Strasbourg (France) for participating in the study. This work has been done using data from The Observatoire Français de la Sclérose en Plaques (OFSEP) which is supported by a grant provided by the French State and handled by the “Agence Nationale de la Recherche”, within the framework of the “Investments for the Future” programme under the reference ANR-10-COHO-002 Observatoire Français de la Sclérose en Plaques (OFSEP), and by the Eugene Devic Foundation against Multiple Sclerosis (EDMUS Foundation).

Compliance with ethical standards

Conflicts of interest

I (Philippe Cabre) assume that none of the authors had a conflict of interest with the content of the present study.

Ethical standard

The ethics committee of Fort de France approved this study. All samples were stored at −80 °C at CERBIM (CHU Martinique) that has been labelled by French Ministry of Health.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Philippe Cabre
    • 1
  • M. Mejdoubi
    • 2
  • S. Jeannin
    • 1
  • H. Merle
    • 3
  • Y. Plumelle
    • 4
  • G. Cavillon
    • 5
  • D. Smadja
    • 1
  • R. Marignier
    • 5
  • On behalf of Francophone Society of Multiple Sclerosis and OFSEP investigators
  1. 1.Department of NeurologyPierre Zobda-Quitman University HospitalFort de FranceMartinique
  2. 2.Department of RadiologyPierre Zobda-Quitman University HospitalFort de FranceMartinique
  3. 3.Department of OphthalmologyPierre Zobda-Quitman University HospitalFort de FranceMartinique
  4. 4.Department of Biological HematologyPierre Zobda-Quitman University HospitalFort de FranceMartinique
  5. 5.Department of NeurologyPierre-Wertheimer Hospital, Civilian Hospices of LyonLyonFrance

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