Highlights
- •Rituximab can reduce the annual recurrence rate, expanded disability status scale and the number of patients who relapse significantly in NMOSD.
- •2.100 mg infusion per week for 3 consecutive weeks may be the suitable dose of rituximab for patients with NMOSD with a low risk of adverse events.
Abstract
Background
Neuromyelitis optica spectrum disease(NMOSD) is an autoimmune neurological disease
that primarily affects the spinal cord, optic nerve, and periventricular organs. Rituximab
plays an important role in the prevention of relapse in NMOSD. In this study, we evaluated
the efficacy and safety of different doses of the anti-monoclonal antibody rituximab
in NMOSD.
Objects
Our study aimed to implement a meta-analysis to systematically assess the efficacy
and safety of different doses of rituximab in the treatment of NMOSD.
Methods
We searched Pubmed, Embase, the Cochrane Library, and Clinicaltrials.gov for relevant
studies evaluating rituximab for NMOSD up to March 2022. Data were assessed using
Review Manager 5.3 and Stata 14 softwares. Means and standard deviations(SD) were
analyzed using random effects models with continuous outcomes. Risk radio was analyzed
using random effects models with dichotomous outcomes. Results: We collected 576 patients
from 17 studies. The endpoint of efficacy was the change in annual recurrence rate(ARR),
expanded disability status scale (EDSS), and the number of patients free of relapse
between pre-treatment and post-treatment of rituximab. We found that rituximab reduced
ARR and EDSS, with a significant reduction in ARR(MD= -1.79, 95% CI: -3.18 ∼ -0.39,
P= 0.01) and EDSS(MD= -1.35, 95% CI: -1.5 ∼ -1.19, P < 0.00001) at 100 mg intravenous
infusion per week for 3 consecutive weeks, meanwhile making the number of patients
free of relapse increased (RR= 24.61 [5.11, 118.55], P<0.0001) and being relatively
safe and without serious adverse events(SAEs). In terms of safety, we compared and
summarised the adverse events(AEs) and SAEs from 17 studies.
Conclusion
In this study, we found rituximab to be relatively safe and efficacious in the treatment
of NMOSD, particularly at a dose of 100mg intravenous infusion per week for 3 consecutive
weeks.
Keywords
Abbreviations:
NMOSD (Neuromyelitis optica spectrum disease), ARR (Annual recurrence rate), EDSS (Expanded disability status scale), SAEs (Serious adverse events), AEs (Adverse events), RTX (Rituximab), MMF (Mycophenolatemofetil), AZA (Azathioprine)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: August 17, 2022
Accepted:
August 16,
2022
Received in revised form:
July 27,
2022
Received:
May 18,
2022
Identification
Copyright
© 2022 Elsevier B.V. All rights reserved.
