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Different doses of Rituximab for the therapy of Neuromyelitis optica spectrum disorder: A systematic review and meta-analysis

  • Kenhui Wei
    Affiliations
    Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, China

    Department of Neurology, Wuxi No. 2 People's Hospital of Nanjing Medical University, Wuxi, Jiangsu Province, China

    Institute of Stroke Research, Soochow University, Suzhou, China
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  • Qianqian Nie
    Affiliations
    Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, China

    Institute of Stroke Research, Soochow University, Suzhou, China
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  • Yunfei Zhu
    Affiliations
    Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, China

    Institute of Stroke Research, Soochow University, Suzhou, China
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  • Haifeng Lu
    Correspondence
    Corresponding authors.
    Affiliations
    Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, China

    Institute of Stroke Research, Soochow University, Suzhou, China
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  • Qun Xue
    Correspondence
    Corresponding authors.
    Affiliations
    Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, China

    Institute of Stroke Research, Soochow University, Suzhou, China
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  • Gang Chen
    Affiliations
    Institute of Stroke Research, Soochow University, Suzhou, China

    Department of Neurosurgery and Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, China
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Published:August 17, 2022DOI:https://doi.org/10.1016/j.msard.2022.104127

      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)
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