Background: Rituximab has been recommended as the first-line therapy for neuromyelitis optica spectrum disorders (NMOSD); however, its regimen is yet to be optimised. We aimed to present our experience of treating adult Chinese patients having NMOSD with low-dose rituximab, and to further investigate its efficacy and safety in a long-term follow-up.
Methods: Twenty adult Chinese patients with NMOSD, who had received rituximab injections, were retrospectively analysed, and followed up over a long time in our hospital. Efficacy was evaluated mainly by the change in expanded disability status scale and annual relapse ratio before and after rituximab therapy. Safety was reflected by the incidence and severity of side effects.
Results: Rituximab regimens, including doses and intervals, varied widely across patients. The median dose was 500 mg, ranging from 100 mg to 1000 mg. The median interval was 6.1 months, ranging from 2 months to 18 months. After rituximab therapy, the median EDSS was stable, whereas median ARR decreased by 90%. Of the 20 patients, 9 suffered from 11 relapses, with relapse-free rate of 55%. Six relapsing cases occurred in less than 6 months from the preceding rituximab injection. Seven cases occurred without CD19+ B cell repopulation. There were 4 cases of infection, including lung and urinary infection; severity ranged from mild to severe across the patients.
Conclusions: We confirmed the long-term efficacy and safety of low-dose rituximab in adult Chinese patients with NMOSD. We recommend monitoring of B cell repopulation to instruct individualised regimens for patients with NMOSD in clinical practice.
Keywords: B cell repopulation; Long-term follow-up; Low-dose rituximab; Neuromyelitis optica spectrum disorders.
Copyright © 2020 Elsevier B.V. All rights reserved.