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

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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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Correspondence to Hélène Zéphir.

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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

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