Department of Neurology, Faculty of Medicine, İzmir Katip Çelebi University, Izmir, Turkey.
Department of Neurology, Cerrahpaşa School of Medicine, Istanbul University, Istanbul, Turkey.
Int J Clin Pract. 2021 Jul;75(7):e14158. doi: 10.1111/ijcp.14158. Epub 2021 Apr 8.
Neuromyelitis optica spectrum disorders (NMOSD) are a group of antibody-mediated chronic inflammatory diseases of the central nervous system. Rituximab is a monoclonal antibody that leads to a reduction in disease activity.
To evaluate the efficacy of rituximab as monotherapy in NMOSD and to determine whether the efficacy varies depending on the presence of antibodies in this cohort.
This multicentre national retrospective study included patients with NMOSD treated with rituximab at least for 12 months from Turkey. The primary outcomes were the change in the annualised relapse rate, the Expanded Disability Status Scale (EDSS), the number of relapse and radiological activity-free patients.
A total of 85 patients with NMOSD were included in the study. Of 85 patients, 58 (68.2%) were seropositive for anti-Aquaporin4-IgG (antI-AQP4-IgG). All patients were Anti-Myelin Oligodendrocyte Glycoprotein IgG (anti-MOG-IgG) negative. The median follow-up for rituximab treatment was 21 months (Q1 16-Q3 34.5). During rituximab treatment, the mean annualised relapse rate (ARR) significantly decreased from 1.45 ± 1.53 to 0.15 ± 0.34 (P < .001). In subgroup analyses, the mean ARR decreased from 1.61 ± 1.65 to 0.20 ± 0.39 in the seropositive group and 1.10 ± 1.19 to 0.05 ± 0.13 in the seronegative group. The mean EDSS improved from 3.98 ± 2.04 (prior to treatment onset) to 2.71 ± 1.59 (at follow-up) (P < .001). In the seropositive group, mean EDSS decreased from 3.94 ± 1.98 to 2.67 ± 1.54, and in the seronegative group, mean EDSS decreased from 4.07 ± 2.21 to 2.79 ± 1.73. There was no significant difference between anti-AQP4-IgG (+) and (-) groups in terms of ARR and EDSS. Sixty-four patients (75.2%) were relapse-free after the initiation of treatment. Seventy patients (82.3%) were radiological activity-free in the optic nerve, area postrema and brainstem. Additionally, 78 patients (91.7%) showed no spinal cord involvement after the treatment.
Rituximab therapy is efficacious in the treatment of Turkish NMOSD patients independent of the presence of the anti-AQP4-IgG antibody.
视神经脊髓炎谱系疾病（NMOSD）是一组由中枢神经系统抗体介导的慢性炎症性疾病。利妥昔单抗是一种导致疾病活动减少的单克隆抗体。
评估利妥昔单抗作为 NMOSD 单药治疗的疗效，并确定在该队列中抗体的存在是否会影响疗效。
这项多中心全国回顾性研究纳入了至少接受利妥昔单抗治疗 12 个月的土耳其 NMOSD 患者。主要结局是年化复发率、扩展残疾状况量表（EDSS）、复发次数和放射学无活动患者的变化。
共纳入 85 例 NMOSD 患者。85 例患者中，58 例（68.2%）抗水通道蛋白 4 抗体（抗 AQP4-IgG）阳性。所有患者抗髓鞘少突胶质细胞糖蛋白 IgG（抗 MOG-IgG）均为阴性。利妥昔单抗治疗的中位随访时间为 21 个月（Q1 16-Q3 34.5）。在利妥昔单抗治疗期间，平均年化复发率（ARR）从 1.45±1.53 显著降低至 0.15±0.34（P<0.001）。在亚组分析中，血清阳性组的平均 ARR 从 1.61±1.65 降至 0.20±0.39，血清阴性组的平均 ARR 从 1.10±1.19 降至 0.05±0.13。EDSS 平均值从治疗前的 3.98±2.04 改善至随访时的 2.71±1.59（P<0.001）。血清阳性组的 EDSS 平均值从 3.94±1.98 降至 2.67±1.54，血清阴性组的 EDSS 平均值从 4.07±2.21 降至 2.79±1.73。ARR 和 EDSS 在抗 AQP4-IgG（+）和（-）组之间无显著差异。治疗开始后，64 例（75.2%）患者无复发。视神经、顶盖后区和脑干的影像学无活动患者有 70 例（82.3%）。此外，治疗后 78 例（91.7%）患者无脊髓受累。
利妥昔单抗治疗对土耳其 NMOSD 患者有效，与抗 AQP4-IgG 抗体的存在无关。
