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Rituximab at lower dose for neuromyelitis optica spectrum disorder: a multicenter, open-label, self-controlled, prospective follow-up study

OBJECTIVE: To address a novel lower-dose rituximab (RTX) therapy strategy based on our clinical experience and assess its efficacy and safety in neuromyelitis optica spectrum disorder (NMOSD). METHODS: A multicenter, open-label, self-controlled, prospective follow-up study. Totally, 108 NMOSD patien...

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Autores principales: Zhao, Daidi, Ren, Kaixi, Lu, Jiarui, Liu, Zhiqin, Li, Zunbo, Wu, Jun, Xu, Zhihao, Wu, Songdi, Lei, Tao, Ma, Chao, Zhao, Sijia, Bai, Miao, Li, Hongzeng, Guo, Jun
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10442836/
https://www.ncbi.nlm.nih.gov/pubmed/37614240
http://dx.doi.org/10.3389/fimmu.2023.1148632
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author Zhao, Daidi
Ren, Kaixi
Lu, Jiarui
Liu, Zhiqin
Li, Zunbo
Wu, Jun
Xu, Zhihao
Wu, Songdi
Lei, Tao
Ma, Chao
Zhao, Sijia
Bai, Miao
Li, Hongzeng
Guo, Jun
author_facet Zhao, Daidi
Ren, Kaixi
Lu, Jiarui
Liu, Zhiqin
Li, Zunbo
Wu, Jun
Xu, Zhihao
Wu, Songdi
Lei, Tao
Ma, Chao
Zhao, Sijia
Bai, Miao
Li, Hongzeng
Guo, Jun
author_sort Zhao, Daidi
collection PubMed
description OBJECTIVE: To address a novel lower-dose rituximab (RTX) therapy strategy based on our clinical experience and assess its efficacy and safety in neuromyelitis optica spectrum disorder (NMOSD). METHODS: A multicenter, open-label, self-controlled, prospective follow-up study. Totally, 108 NMOSD patients were enrolled and a lower-dose RTX strategy was applied including 100 mg weekly for 3 weeks and then reinfusions every 6 months. Annualized relapse rate (ARR), the expanded disability status scale (EDSS) score and length of spinal cord lesions were included to evaluate the efficacy. Side effects were recorded to assess the safety profile. RESULTS: Of 108 patients, 80 (74.1%) initiated low-dose RTX therapy immediately after acute attack treatment and 33 (30.6%) initiated it after the first attack. During a median treatment period of 35.5 (22.0–48.8) months, significant decreases were observed in median ARR (1.1 [0.8–2.0] versus 0 [0–0.2], p < 0.001), EDSS score (3.5 [2.5–4.0] versus 2.0 [1.0–3.0], p < 0.001) and spinal cord lesion segments (5.0 [4.0–8.0] versus 3.0 [1.0–6.0], p < 0.001). The cumulative risk of relapses significantly decreased during the post- versus pre-RTX period (HR 0.238, 95%CI 0.160–0.356, p < 0.001) and on early therapy initiated within 24 months after disease onset versus delayed therapy (HR 0.506, 95%CI 0.258–0.994, p = 0.041). No serious side effects were recorded and all the subjects did not discontinue treatment due to RTX-related side effects. CONCLUSION: Our research provided evidence supporting the lower-dose RTX strategy in treating NMOSD and reopened the issues of optimal dosage and therapy initiation timing.
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spelling pubmed-104428362023-08-23 Rituximab at lower dose for neuromyelitis optica spectrum disorder: a multicenter, open-label, self-controlled, prospective follow-up study Zhao, Daidi Ren, Kaixi Lu, Jiarui Liu, Zhiqin Li, Zunbo Wu, Jun Xu, Zhihao Wu, Songdi Lei, Tao Ma, Chao Zhao, Sijia Bai, Miao Li, Hongzeng Guo, Jun Front Immunol Immunology OBJECTIVE: To address a novel lower-dose rituximab (RTX) therapy strategy based on our clinical experience and assess its efficacy and safety in neuromyelitis optica spectrum disorder (NMOSD). METHODS: A multicenter, open-label, self-controlled, prospective follow-up study. Totally, 108 NMOSD patients were enrolled and a lower-dose RTX strategy was applied including 100 mg weekly for 3 weeks and then reinfusions every 6 months. Annualized relapse rate (ARR), the expanded disability status scale (EDSS) score and length of spinal cord lesions were included to evaluate the efficacy. Side effects were recorded to assess the safety profile. RESULTS: Of 108 patients, 80 (74.1%) initiated low-dose RTX therapy immediately after acute attack treatment and 33 (30.6%) initiated it after the first attack. During a median treatment period of 35.5 (22.0–48.8) months, significant decreases were observed in median ARR (1.1 [0.8–2.0] versus 0 [0–0.2], p < 0.001), EDSS score (3.5 [2.5–4.0] versus 2.0 [1.0–3.0], p < 0.001) and spinal cord lesion segments (5.0 [4.0–8.0] versus 3.0 [1.0–6.0], p < 0.001). The cumulative risk of relapses significantly decreased during the post- versus pre-RTX period (HR 0.238, 95%CI 0.160–0.356, p < 0.001) and on early therapy initiated within 24 months after disease onset versus delayed therapy (HR 0.506, 95%CI 0.258–0.994, p = 0.041). No serious side effects were recorded and all the subjects did not discontinue treatment due to RTX-related side effects. CONCLUSION: Our research provided evidence supporting the lower-dose RTX strategy in treating NMOSD and reopened the issues of optimal dosage and therapy initiation timing. Frontiers Media S.A. 2023-08-08 /pmc/articles/PMC10442836/ /pubmed/37614240 http://dx.doi.org/10.3389/fimmu.2023.1148632 Text en Copyright © 2023 Zhao, Ren, Lu, Liu, Li, Wu, Xu, Wu, Lei, Ma, Zhao, Bai, Li and Guo https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Immunology
Zhao, Daidi
Ren, Kaixi
Lu, Jiarui
Liu, Zhiqin
Li, Zunbo
Wu, Jun
Xu, Zhihao
Wu, Songdi
Lei, Tao
Ma, Chao
Zhao, Sijia
Bai, Miao
Li, Hongzeng
Guo, Jun
Rituximab at lower dose for neuromyelitis optica spectrum disorder: a multicenter, open-label, self-controlled, prospective follow-up study
title Rituximab at lower dose for neuromyelitis optica spectrum disorder: a multicenter, open-label, self-controlled, prospective follow-up study
title_full Rituximab at lower dose for neuromyelitis optica spectrum disorder: a multicenter, open-label, self-controlled, prospective follow-up study
title_fullStr Rituximab at lower dose for neuromyelitis optica spectrum disorder: a multicenter, open-label, self-controlled, prospective follow-up study
title_full_unstemmed Rituximab at lower dose for neuromyelitis optica spectrum disorder: a multicenter, open-label, self-controlled, prospective follow-up study
title_short Rituximab at lower dose for neuromyelitis optica spectrum disorder: a multicenter, open-label, self-controlled, prospective follow-up study
title_sort rituximab at lower dose for neuromyelitis optica spectrum disorder: a multicenter, open-label, self-controlled, prospective follow-up study
topic Immunology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10442836/
https://www.ncbi.nlm.nih.gov/pubmed/37614240
http://dx.doi.org/10.3389/fimmu.2023.1148632
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