Peer-review started: November 11, 2014
First decision: December 26, 2014
Revised: January 12, 2015
Accepted: February 4, 2015
Article in press: February 9, 2015
Published online: March 28, 2015
Processing time: 141 Days and 0.5 Hours
Neuromyelitis optica spectrum disorders, or neuromyelitis optica (NMO), is an autoimmune disease of the central nervous system that must be distinguished from multiple sclerosis. Therapeutic approaches to relapse prevention in NMO include immunosuppressants and monoclonal antibodies. Rituximab, a monoclonal antibody that targets CD20 antigen expressed on the surface of pre-B, mature B-lymphocytes and a small subset of T-lymphocytes, has been widely used for the treatment of NMO. In this review, we aim to summarize global experience with rituximab in NMO. We identified 13 observational studies that involved a total of 209 NMO patients treated with rituximab. Majority of rituximab-treated patients evidenced stabilization or improvements in their disability scores compared to pre-treatment period and 66% of patients remained relapse-free during treatment period. Monitoring rituximab treatment response with CD19+ or CD27+ cell counts appears to improve treatment outcomes. We offer clinical pointers on rituximab use for NMO based on the literature and authors’ experience, and pose questions that would need to be addressed in future studies.
Core tip: Relapsing neuromyelitis optica (NMO) is an autoimmune disorder of the central nervous system that often results in severe disability and death if untreated. Rituximab, an anti-CD20 monoclonal antibody, appears to be a promising treatment option for NMO. In this review, we summarize the results of 13 observational studies that assessed efficacy of Rituximab in neuromyelitis optica. On average, 66% of patients remained relapse-free during treatment period and in the majority of patients disability scores have stabilized or improved. Monitoring response to rituximab with CD19+ and CD 27+ cell counts appears to improve outcomes.