Clinical evaluation of rituximab treatment for neuromyelitis optica

Neuromyelitis optica is an inflammatory and usually relapsing demyelinating autoimmune disease of the central nervous system that targets the optic nerves and spinal cord. Rituximab has been used for different neurological diseases that are probably immune-mediated or involving humoral immunity. The objective of this study is to evaluate the efficacy and safety of rituximab as treatment for neuromyelitis optica in a tertiary hospital. Retrospective study of patients with neuromyelitis optica treated with rituximab 1000mg on days 1 and 15, repeated every 6–8 months. We recorded EDSS score, relapse rate, overall condition, CD19+ count, presence of anti-NMO antibodies, and possible adverse reactions. Six patients were treated; all were women with a median age of 46 years (range 38–58). Anti-NMO antibodies were detected in 3 patients (50%). Baseline EDSS was 4 (range 2.0–5.5). Two patients had previously been treated with an immunomodulatory drug. Median time from the first rituximab infusion to first relapse was 3.7 years (range 1.7–6.9). Two patients had infusion reactions after the first dose of rituximab. Four patients remained relapse-free and their EDSS score did not progress during rituximab treatment, one patient showed no clinical improvement, and one patient could not be evaluated. Rituximab can be considered an attractive therapeutic alternative for patients with neuromyelitis optica as there are no approved treatments for this disease. Further studies with rituximab are needed to establish the role of this drug in treating neuromyelitis optica. La neuromielitis óptica es un trastorno autoinmune, inflamatorio y desmielinizante del sistema nervioso central que afecta a la médula espinal y al nervio óptico, de carácter recurrente. Rituximab ha sido utilizado en el tratamiento de varias enfermedades neurológicas de probable naturaleza autoinmune o donde la inmunidad humoral estaba implicada. El objetivo de este estudio es evaluar la eficacia y seguridad de rituximab en el tratamiento de la neuromielitis óptica en un hospital terciario. Estudio retrospectivo de pacientes con neuromielitis óptica tratadas con 2 infusiones de rituximab 1.000mg separadas por 15 días, cada 6–8 meses. Se evaluó la puntuación EDSS, la existencia de brotes, el estado general, el recuento de CD19+, la presencia de anticuerpos anti-NMO y las reacciones adversas. Se trataron 6 pacientes, todas mujeres (mediana de edad 46 años; rango 38–58). En 3 de ellas (50%) se detectó la prese