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

Journal of Neurology volume 262, pages 2329–2335 (2015)Cite this article

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.

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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.

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Affiliations

  1. Clinique Neurologique, Hôpital Roger Salengro, CHRU de Lille, Université de Lille, Lille, France

    Hélène Zéphir & Olivier Outteryck

  2. Pole des Neurosciences, CHU Toulouse and UMR 1043, Université de Toulouse III, Toulouse, France

    Raphaël Bernard-Valnet & David Brassat

  3. Service de Neurologie, Hôpital Pasteur, CHU de Nice, Nice, France

    Christine Lebrun

  4. Service de Neurologie, Hôpital Universitaire de la Timone, Marseille, France

    Bertrand Audoin

  5. Service de Neurologie, CHU de Rouen, Rouen, France

    Bertrand Bourre

  6. Service de Neurologie, Hôpital Central, Nancy, France

    Sophie Pittion

  7. Service de Neurologie, CHU de Nantes, Nantes, France

    Sandrine Wiertlewski

  8. Service de Neurologie, CHU de Bordeaux, Bordeaux, France

    Jean Christophe Ouallet

  9. Service de Neurologie, CHU de Poitiers, Poitiers, France

    Jean-Philippe Neau & Jonathan Ciron

  10. Service de Neurologie, CHU de Clermont-Ferrand, Clermont-Ferrand, France

    Pierre Clavelou

  11. Service de Neurologie, Hôpital Wertheimer, Hospices Civils de Lyon, Bron, France

    Romain Marignier

Authors
  1. Hélène Zéphir
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  2. Raphaël Bernard-Valnet
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  3. Christine Lebrun
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  4. Olivier Outteryck
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  5. Bertrand Audoin
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  6. Bertrand Bourre
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  7. Sophie Pittion
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  8. Sandrine Wiertlewski
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  9. Jean Christophe Ouallet
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  10. Jean-Philippe Neau
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  11. Jonathan Ciron
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  12. Pierre Clavelou
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  13. Romain Marignier
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  14. David Brassat
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Corresponding author

Correspondence to Hélène Zéphir.

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None of authors have conflict of interest with this study.

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On behalf of SFSEP and NOMADMUS.

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Zéphir, H., Bernard-Valnet, R., Lebrun, C. et al. Rituximab as first-line therapy in neuromyelitis optica: efficiency and tolerability. J Neurol 262, 2329–2335 (2015). https://doi.org/10.1007/s00415-015-7852-y

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  • DOI: https://doi.org/10.1007/s00415-015-7852-y

Keywords

  • Neuromyelitis optica
  • Rituximab
  • Immunosuppression
  • Aquaporin 4
  • Relapse free
  • B Cell depletion