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Treatment of neuromyelitis optica and neuromyelitis optica spectrum disorders with rituximab using a maintenance treatment regimen and close CD19 B cell monitoring. A six-year follow-up.
J Neurol Sci 2017; 372:92-96JN

Abstract

Neuromyelitis optinca (NMO) represents a serious demyelinating disease of the central nervous system selectively attacking the spinal cord and optic nerve. Early differential diagnosis from multiple sclerosis is of vital importance, as NMO mandates immunosuppressive and not immunomodulatory treatment. Rituximab has been recently introduced as a treatment option for NMO. However, optimal surrogate measures and treatment intervals are still unclear. Five patients (females, mean age 54±10.21years) with NMO and NMO spectrum disorders (NMOSD) were evaluated with respect to disability and relapse rate. All patients were found positive for NMO IgG. All patients (three with NMO and two with NMOSD, 1 patient with recurrent optic neuritis and 1 patient with recurrent myelitis) had received rituximab treatment for six years. One patient with NMOSD received cyclophosphamide prior to rituximab while two were misdiagnosed as multiple sclerosis and had received interferon treatment. All received rituximab infusion of 375mg/m2 once per week for 4weeks and then every two months for the first two years and then every six months. B-cell counts were measured every two months and were kept in almost undetectable levels. No relapse was noted during the treatment period while EDSS score was improved in all patients. No severe adverse effects occurred during RTX treatment. Rituximab treatment on NMO and NMOSD patients showed significant improvement in disability and relapse-rate without any significant adverse effects.

Authors+Show Affiliations

Demyelinating Diseases Unit, Department of Neurology, Eginition Hospital, National and Kapodistrian University of Athens, Greece. Electronic address: evangelopoulos@yahoo.gr.Demyelinating Diseases Unit, Department of Neurology, Eginition Hospital, National and Kapodistrian University of Athens, Greece.Demyelinating Diseases Unit, Department of Neurology, Eginition Hospital, National and Kapodistrian University of Athens, Greece.Department of Radiology, Aretaieion Hospital, National and Kapodistrian University of Athens, Greece.Demyelinating Diseases Unit, Department of Neurology, Eginition Hospital, National and Kapodistrian University of Athens, Greece.Demyelinating Diseases Unit, Department of Neurology, Eginition Hospital, National and Kapodistrian University of Athens, Greece.3rd Department of Orthopaedic Surgery, KAT Hospital, National and Kapodistrian University of Athens, Greece.Demyelinating Diseases Unit, Department of Neurology, Eginition Hospital, National and Kapodistrian University of Athens, Greece.Demyelinating Diseases Unit, Department of Neurology, Eginition Hospital, National and Kapodistrian University of Athens, Greece.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28017256

Citation

Evangelopoulos, M E., et al. "Treatment of Neuromyelitis Optica and Neuromyelitis Optica Spectrum Disorders With Rituximab Using a Maintenance Treatment Regimen and Close CD19 B Cell Monitoring. a Six-year Follow-up." Journal of the Neurological Sciences, vol. 372, 2017, pp. 92-96.
Evangelopoulos ME, Andreadou E, Koutsis G, et al. Treatment of neuromyelitis optica and neuromyelitis optica spectrum disorders with rituximab using a maintenance treatment regimen and close CD19 B cell monitoring. A six-year follow-up. J Neurol Sci. 2017;372:92-96.
Evangelopoulos, M. E., Andreadou, E., Koutsis, G., Koutoulidis, V., Anagnostouli, M., Katsika, P., ... Kilidireas, C. (2017). Treatment of neuromyelitis optica and neuromyelitis optica spectrum disorders with rituximab using a maintenance treatment regimen and close CD19 B cell monitoring. A six-year follow-up. Journal of the Neurological Sciences, 372, pp. 92-96. doi:10.1016/j.jns.2016.11.016.
Evangelopoulos ME, et al. Treatment of Neuromyelitis Optica and Neuromyelitis Optica Spectrum Disorders With Rituximab Using a Maintenance Treatment Regimen and Close CD19 B Cell Monitoring. a Six-year Follow-up. J Neurol Sci. 2017 Jan 15;372:92-96. PubMed PMID: 28017256.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Treatment of neuromyelitis optica and neuromyelitis optica spectrum disorders with rituximab using a maintenance treatment regimen and close CD19 B cell monitoring. A six-year follow-up. AU - Evangelopoulos,M E, AU - Andreadou,E, AU - Koutsis,G, AU - Koutoulidis,V, AU - Anagnostouli,M, AU - Katsika,P, AU - Evangelopoulos,D S, AU - Evdokimidis,I, AU - Kilidireas,C, Y1 - 2016/11/10/ PY - 2016/06/14/received PY - 2016/10/16/revised PY - 2016/11/08/accepted PY - 2016/12/27/entrez PY - 2016/12/27/pubmed PY - 2017/5/31/medline KW - Neuromyelitis optica KW - Neuromyelitis optica spectrum disorders KW - Rituximab treatment SP - 92 EP - 96 JF - Journal of the neurological sciences JO - J. Neurol. Sci. VL - 372 N2 - Neuromyelitis optinca (NMO) represents a serious demyelinating disease of the central nervous system selectively attacking the spinal cord and optic nerve. Early differential diagnosis from multiple sclerosis is of vital importance, as NMO mandates immunosuppressive and not immunomodulatory treatment. Rituximab has been recently introduced as a treatment option for NMO. However, optimal surrogate measures and treatment intervals are still unclear. Five patients (females, mean age 54±10.21years) with NMO and NMO spectrum disorders (NMOSD) were evaluated with respect to disability and relapse rate. All patients were found positive for NMO IgG. All patients (three with NMO and two with NMOSD, 1 patient with recurrent optic neuritis and 1 patient with recurrent myelitis) had received rituximab treatment for six years. One patient with NMOSD received cyclophosphamide prior to rituximab while two were misdiagnosed as multiple sclerosis and had received interferon treatment. All received rituximab infusion of 375mg/m2 once per week for 4weeks and then every two months for the first two years and then every six months. B-cell counts were measured every two months and were kept in almost undetectable levels. No relapse was noted during the treatment period while EDSS score was improved in all patients. No severe adverse effects occurred during RTX treatment. Rituximab treatment on NMO and NMOSD patients showed significant improvement in disability and relapse-rate without any significant adverse effects. SN - 1878-5883 UR - https://www.unboundmedicine.com/medline/citation/28017256/Treatment_of_neuromyelitis_optica_and_neuromyelitis_optica_spectrum_disorders_with_rituximab_using_a_maintenance_treatment_regimen_and_close_CD19_B_cell_monitoring__A_six_year_follow_up_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0022-510X(16)30711-0 DB - PRIME DP - Unbound Medicine ER -