Rituximab in neuromyelitis optica: A review of literature

Table 1 Case series of rituximab in neuromyelitis optica

Ref.	Country; Type of study	No. of patients (n = 209)	Mean age at RTX; % Female	% Anti-AQP4 Ab seropositive	RTX Protocol /treatment duration	ARR before RTX	ARR after RTX	% Relapse-free	EDSS (median) before --> after RTX
Cree et al[20]	United States; Retrospective	8	371; 88%	N/A	A- treatment B- retreatment	2.6 (median)	0 (median)	75% (6/8 pts at 12 mo f/u)	7.5--> 5.5
Jacob et al[23]	United States/England; Retrospective	25	431; 88%	70%	A or B; median interval between cycles-8 mo 19 mo follow up	1.7 (median)	0 (median)	72% (17/25 at 12 mo estimated)	7--> 5 2 patients deceased
Bomprezzi et al[31]	United States; Retrospective	18	46 (+/-12); 83%	67%	B	15 pts-RTX tx and 7 had relapses. 42% (5/12) showed “positive treatment effects”, the other 7 continued to relapse despite RTX therapy		53% (8/15)	Severe disability from NMO’ - 10 patients
Bedi et al[24]	United States; Retrospective	23	461; 91%	72%	A or B; 32.5 mo	1.87 (median)	0 (median)	74 % (17/23 pts)	7--> 5.5
Pellkofer et al[30]	Germany; Prospective	10	471; 90%	100%	B; number of cycles of RTX 1-5	Ever before RTX: 1.3 mo, 12 m before RTX: 2.4 mo, 24 m before RTX: 1.72 mo, With RTX: 0.93 mo		50% (5/10 at 12 mo estimated)	6--> 6.51 1 patient deceased
Javed et al[22]	United States; Retrospective	15	34; N/A	N/A	B; patients were given RTX 1g x1 usually 6-9 mo after the initial dose	2/10 had 2 relapses in 6 mo post RX. 5 non-responders had mean of 1.45 (median 1) relapses in mean 12.2 (median 10) mo		67% (RTX delayed further relapses for 9 mo or more)	N/A
Gredler et al[26]	Austria; Retrospective	6	38; 83%	66%	375 mg/m2; no of infusions 3-16 (mean = 6.67), interval between infusions 3.3-11 mo	2.5 (mean)1	0.4 (mean)1	67% (4/6)	5.25--> 2.251
Ip et al[25]	China; Prospective	7	52; 85%	66%	A or B: Mean # trx courses: 2.85. median 2	Mean ARR = 2.4 median ARR = 21 5 became relapse free. 2 had 50% reduction over median 24 mo		71 % (5/7)	8--> 7
Lindsey et al[32]	United States; Retrospective	9	N/A; 89%	60%	A or B: Mean duration: 74.2 mo	3 pts with early relapses in first month after RTX, 4 pts (including 1 pt with early relapse) with later relapses		33% (3/9)	3.5--> 4.31
Kim et al[27]	South Korea; Retrospective	30	38.4 (± 10.5); 90%	77%	A or B; mean 61 mo (range 49-82 mo), median 60 mo	2.4 (mean)	0.3 (mean)	70% (21/30 at 2 yr f/u)	4--> 3
Yang et al[28]	China; Prospective	5	421; N/A	80%	100 mg (50-59 mg/m2) RTX IV 1 dose/wk for 3 cons wk; mean duration: 12.2 mo	1.161 (mean)	01 (mean)	100%	4.5--> 4
Mealy et al[29]	United States; Retrospective	30	451; 83%	50%	B; median of 20 mo (range 5-83 mo)	Total pretreatment ARR- 2.89	Total post-treatment ARR- 0.33	67% (20/30)	N/A
Farber et al[21]	United States; Retrospective	23	38; 100%	74%	Mean of 22 mo (range 2-96 mo)		Median ARR was 0.24; mean was 1.02 (SD = 1.36)	48% (11/23)	N/A

¹Estimated based on results table or manuscript when possible. A or B (in RTX protocol column): There were two treatment protocols used- Protocol A with 4 doses RTX 375 mg/m² IV wk for 4 wk; Protocol B with 2 doses of RTX 1000 mg IV 2 wk apart. NMO: Neuromyelitis optica; ARR: Annual relapse rate; EDSS: Expanded disability status scale; RTX: Rituximab; AQP4: Ab - aquaporin 4 antibody; N/A: Not available.