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Analysis of the treatment of neuromyelitis optica

Published:February 12, 2015DOI:https://doi.org/10.1016/j.jns.2015.02.012

      Highlights

      • Rituximab significantly reduces annualized relapse rates in patients with NMO.
      • Rituximab significantly improves disability in patients with NMO.
      • When compared to azathioprine rituximab significantly reduced relapse rates.
      • Rituximab has comparable tolerability to other immunosuppressive treatments for NMO.

      Abstract

      Background

      Treatment options for neuromyelitis optica (NMO) are currently based on small retrospective case series and open label studies, ranging from 10 to 103 patients.

      Objective

      To compare the efficacy and tolerability of azathioprine, cyclophosphamide, mycophenolate, and rituximab in patients with neuromyelitis optica.

      Methods

      This is a retrospective chart review and telephone follow-up study of 71 patients with NMO or NMO spectrum disorder, 54 of whom were treated with the study drugs. We compared adverse events, annualized relapse rates and expanded disability status scales before and after treatment.

      Results

      The median ARR decreased from 1.17 to 0.25 on rituximab (P < 0.01), 0.92 to 0.56 on azathioprine (P = 0.475), 1.06 to 0.39 on mycophenolate (P < 0.05) and 1.30 to 0.92 on cyclophosphamide (P = 0.746). When compared directly to azathioprine, rituximab significantly reduced relapse rates (P = 0.021). The median EDSS decreased from 7 to 5 on rituximab (P < 0.01) and 7 to 6 on azathioprine (P < 0.01), and did not change significantly on mycophenolate (4 to 5; P = 0.463) or cyclophosphamide (6.5 to 6.5; P = 0.881). Twenty-five percent of patients noted adverse events on rituximab, 36% on azathioprine, 36% on mycophenolate, and 80% on cyclophosphamide.

      Conclusion

      Rituximab significantly reduces relapse rates and improves disability while maintaining comparable tolerability to other immunosuppressive treatments for NMO.

      Keywords

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