Evaluation of neuromyelitis optica spectrum disorder in patients under rituximab and applicability of no responsiveness criteria for first-line therapies: real-world data in settings with limited resources

Address for correspondence: Ivna Lacerda Pereira Nóbrega (email: [e-mail]).

Abstract

Background: Neuromyelitis optica spectrum disorder (NMOSD) is an autoimmune astrocytophaty that primarily affects the optic nerve, spinal cord, and periventricular areas. Although new medications have been approved for the management of NMOSD, to date there is no universal treatment protocol, and accessibility is heterogeneous, especially in resource-limited settings. The current treatment options include classic immunosuppressants (IS) and rituximab (RTX).

Objective: To analyze the clinical and epidemiological profile of patients with NMOSD using RTX, and to evaluate whether patients who have failed classic IS and were escalated to RTX can be identified early based on clinical and demographic criteria.

Methods: The present was a single-center retrospective study which included NMOSD patients under classic IS and RTX treatment from 1995 to November 2022. Failure was considered as one severe relapse. In the population receiving RTX as a second-line therapy, the clinical predictors of non-responsiveness to classic IS used as criteria were age under 35 years and severe attack at disease onset.

Results: Out of 105 NMOSD patients regularly followed up at our reference center, 26% (n = 27) were under RTX treatment, with median follow-up of 108 months. Out of those, 96% (n = 26) were female, with a median age of 41 (range: 21–77) years, and a median EDSS score of 4 (range: 1–8.5); 85% (n = 23) were anti-AQP4 seropositive, and 88.8% (n = 24) were relapse-free under RTX treatment. Out of the 20% (n = 21) using RTX as a second-line therapy, 30.7% met both criteria: disease onset under 35 years of age and severe attack that determined a risk of 22.5% of not responding to classic IS, while the absence of both criteria was associated with a 4.6% risk.

Conclusion: Rituximab is likely an effective drug for NMOSD treatment in a resource-limited and real-world setting. Younger age and severe attack at disease onset can be used as predictors of poor response to classic IS and support the early initiation of highly-effective medications.

 

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No conflict of interest has been declared by the author(s).

Publication History

Article published online:
02 October 2024