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Early rituximab treatment reduces long-term disability in aquaporin-4 antibody-positive neuromyelitis optica spectrum

Authors
Park, Su YeonKwon, Young NamKim, SunyoungKim, Seung-HyunKim, Jong KukKim, Jun-SoonNam, Tai-SeungMin, Young GiPark, Kyung SeokPark, Jin-SungSeok, Jin MyoungSung, Jung-JoonSohn, EunheeShin, Kyong JinShin, Jin-HongShin, Ha YoungOh, Seong-ilOh, JeeyoungYoon, Byeol-ALee, SanggonLee, Jong-MokLee, Hye LimChoi, KyominHuh, So-YoungJang, Myoung-jinMin, Ju-HongKim, Byoung JoonKim, Sung-Min
Issue Date
Oct-2023
Publisher
BMJ Publishing Group
Keywords
NEUROIMMUNOLOGY
Citation
Journal of Neurology, Neurosurgery and Psychiatry, v.94, no.10, pp 800 - 805
Pages
6
Indexed
SCIE
SCOPUS
Journal Title
Journal of Neurology, Neurosurgery and Psychiatry
Volume
94
Number
10
Start Page
800
End Page
805
URI
https://scholarworks.korea.ac.kr/kumedicine/handle/2021.sw.kumedicine/63520
DOI
10.1136/jnnp-2022-330714
ISSN
0022-3050
1468-330X
Abstract
Background Neuromyelitis optica spectrum disorder (NMOSD) causes relapsing inflammatory attacks in the central nervous system, leading to disability. As rituximab, a B-lymphocyte-depleting monoclonal antibody, is an effective in preventing NMOSD relapses, we hypothesised that earlier initiation of rituximab can also reduce long-term disability of patients with NMOSD. Methods This multicentre retrospective study involving 19 South Korean referral centres included patients with NMOSD with aquaporin-4 antibodies receiving rituximab treatment. Factors associated with the long-term Expanded Disability Status Scale (EDSS) were assessed using multivariable regression analysis. Results In total, 145 patients with rituximab treatment (mean age of onset, 39.5 years; 88.3% female; 98.6% on immunosuppressants/oral steroids before rituximab treatment; mean disease duration of 121 months) were included. Multivariable analysis revealed that the EDSS at the last follow-up was associated with time to rituximab initiation (interval from first symptom onset to initiation of rituximab treatment). EDSS at the last follow-up was also associated with maximum EDSS before rituximab treatment. In subgroup analysis, the time to initiation of rituximab was associated with EDSS at last follow-up in patients aged less than 50 years, female and those with a maximum EDSS score ≥6 before rituximab treatment. Conclusions Earlier initiation of rituximab treatment may prevent long-term disability worsening in patients with NMOSD, especially among those with early to middle-age onset, female sex and severe attacks.
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Guro Hospital (Department of Neurology, Guro Hospital)
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