Trewin Benjamin P, Adelstein Stephen, Spies Judith M, Beadnall Heidi N, Barton Joshua, Ho Nicholas, Gallagher Kerri J, Barnett Michael H
Neurology, Royal Prince Alfred Hospital (RPAH), Australia; Brain & Mind Centre, University of Sydney (USyd), Australia.
Immunology, RPAH, Australia; Faculty of Medicine & Health, USyd, Australia.
Mult Scler Relat Disord. 2020 Aug;43:102175. doi: 10.1016/j.msard.2020.102175. Epub 2020 May 11.
B-cell depleting treatments are widely used to modify the course of neuromyelitis optica spectrum disorder (NMOSD). Despite recent successful Phase 3 trials of several novel NMOSD therapies, limited availability and high cost constrains their clinical use, and rituximab (RTX) remains a core treatment in many centres. Since 2013, the Royal Prince Alfred Hospital Neuroimmunology Clinic (NIC) has regularly measured class-switched memory B-cells (SMB-cells) in the peripheral blood of patients with NMOSD, who have been treated with RTX, in order to guide retreatment intervals.
To assess the management and outcomes of the treated patients, and to determine the effect of SMB-cell monitoring in guiding retreatment intervals.
A retrospective analysis of hospital records, clinic letters and laboratory data was performed.
Sixteen patients with NMOSD received individualised rituximab dosing at NIC between 2013 and 2018. Fourteen (87.5%) were aquaporin-4 antibody (AQP4-Ab) positive; 1 (6.25%) was myelin oligodendrocyte glycoprotein antibody (MOG-Ab) positive and 1 (6.25%) was seronegative. After commencement of RTX, individually dosed according to regular measurements of serum SMB-cells, there was a 77.5% reduction in annualised relapse rate over a mean follow-up time of 46.1 months in our recently active NMOSD patients. Their mean retreatment interval was 50.9 weeks.
This study provides real-world evidence supporting individualised rituximab dosing in the treatment of NMOSD.
B细胞耗竭疗法被广泛用于改变视神经脊髓炎谱系障碍（NMOSD）的病程。尽管最近几种新型NMOSD疗法的3期试验取得了成功，但可用性有限和成本高昂限制了它们的临床应用，利妥昔单抗（RTX）在许多中心仍然是核心治疗药物。自2013年以来，皇家阿尔弗雷德王子医院神经免疫学诊所（NIC）定期测量接受RTX治疗的NMOSD患者外周血中的类别转换记忆B细胞（SMB细胞），以指导再次治疗的间隔时间。
评估接受治疗患者的管理情况和结局，并确定SMB细胞监测在指导再次治疗间隔时间方面的效果。
对医院记录、诊所信件和实验室数据进行回顾性分析。
2013年至2018年期间，16例NMOSD患者在NIC接受了个体化的利妥昔单抗给药。14例（87.5%）水通道蛋白4抗体（AQP4-Ab）阳性；1例（6.25%）髓鞘少突胶质细胞糖蛋白抗体（MOG-Ab）阳性，1例（6.25%）血清学阴性。根据血清SMB细胞的定期测量进行个体化给药后，在我们最近活动的NMOSD患者中，平均随访46.1个月期间，年化复发率降低了77.5%。他们的平均再次治疗间隔时间为50.9周。
本研究提供了支持在NMOSD治疗中进行个体化利妥昔单抗给药的真实世界证据。
