Carlsson Olof, Jonsson Dagur Ingi, Brundin Lou, Iacobaeus Ellen
Department of Clinical Neuroscience, Karolinska Institute, 171 64 Solna, Sweden.
Department of Neurology, Karolinska University Hospital, 171 76 Stockholm, Sweden.
J Clin Med. 2024 Jan 8;13(2):355. doi: 10.3390/jcm13020355.
Neuromyelitis optica spectrum disorder (NMOSD) is a rare immune-mediated relapsing-remitting disease of the central nervous system. The usage of rituximab, as relapse-preventive therapy, in NMOSD is common. We performed a single-center retrospective cohort study to assess the risk of relapses and severe infectious events (SIEs) in rituximab-treated NMOSD patients. This study included 24 aquaporin-4 IgG+ (AQP4+), 8 myelin-oligodendrocyte-protein IgG+ (MOG+), and 10 double-seronegative NMOSD patients. Relapses were observed in 50% of all patients during a mean treatment time of 4.0 (range: 0.5-8.25) years. The incidence risk ratio (IRR) of relapse was three times higher in MOG+ compared to AQP4+ patients (IRR: 3.0, 95% confidence interval (CI); 1.2-7.7). SIEs occurred in 40% of all patients during follow-up. AQP4+ patients conferred an increased risk of SIEs compared to MOG+ patients (IRR; 5.3, 95% CI; 1.2-24.3). Incomplete CD19+ B-lymphocyte suppression was not correlated with relapse risk (hazard ratio; 1.9, 95% CI; 0.7-5.2), and there was no correlation between IgG-levels and SIE risk (odds ratio; 2.0, 95% CI; 0.8-4.8). In conclusion, considerable risks of both relapses and SIEs were observed in NMOSD patients exposed to rituximab, which underlines the need for close clinical vigilance of disease activity and infections during treatment.
视神经脊髓炎谱系障碍（NMOSD）是一种罕见的中枢神经系统免疫介导的复发缓解性疾病。利妥昔单抗作为预防复发的疗法，在NMOSD中的使用很常见。我们进行了一项单中心回顾性队列研究，以评估接受利妥昔单抗治疗的NMOSD患者的复发风险和严重感染事件（SIEs）。本研究纳入了24例水通道蛋白4 IgG阳性（AQP4+）、8例髓鞘少突胶质细胞糖蛋白IgG阳性（MOG+）和10例双血清阴性的NMOSD患者。在平均4.0（范围：0.5 - 8.25）年的治疗时间内，所有患者中有50%出现复发。与AQP4+患者相比，MOG+患者的复发发病率风险比（IRR）高出三倍（IRR：3.0，95%置信区间（CI）；1.2 - 7.7）。在随访期间，所有患者中有40%发生了SIEs。与MOG+患者相比，AQP4+患者发生SIEs的风险增加（IRR；5.3，95% CI；1.2 - 24.3）。CD19+B淋巴细胞抑制不完全与复发风险无关（风险比；1.9，95% CI；0.7 - 5.2），IgG水平与SIE风险之间也无相关性（优势比；2.0，95% CI；0.8 - 4.8）。总之，在接受利妥昔单抗治疗的NMOSD患者中观察到了相当高的复发和SIEs风险，这突出了在治疗期间密切临床监测疾病活动和感染的必要性。
