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

Background: Neuromyelitis 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.
Methods: This 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.
Results: In 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.
Conclusions: Earlier 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.
Competing Interests: Competing interests: S-MK has lectured, consulted and received honoraria from Bayer Schering Pharma, Genzyme, Merck Serono and UCB; received a grant from the National Research Foundation of Korea and the Korea Health Industry Development Institute Research. S-MK and KSP are associate editors of the Journal of Clinical Neurology. S-MK, KSP, Seoul National University and Seoul National University Hospital have transferred the technology of the flow cytometric autoantibody assay to the EONE Laboratory, Korea. Byoung Joon Kim; honoraria/consulting fees (Biogen, Genzyme, Merck, Sanofi, Astellas, Merk); member of advisory boards (Astellas, Korean FDA).
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