This Article  • Full text  • PDF  • CME Course for This Article  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (8)  • Contact me when this article is cited  Related Content  • Related article  • Similar articles in this journal  Topic Collections  • Multiple Sclerosis/ Demyelinating Disease  • Neuro-ophthalmology  • Rehabilitation Medicine  • Prognosis/ Outcomes  • Drug Therapy  • Drug Therapy, Other  • Alert me on articles by topic  Social Bookmarking   What's this?

Retrospective Analysis of 25 Patients

Anu Jacob, MD, MRCP, DM; Brian G. Weinshenker, MD; Ivo Violich, BS; Nancy McLinskey, MD; Lauren Krupp, MD; Robert J. Fox, MD; Dean M. Wingerchuk, MD; Mike Boggild, MD, MRCP; Cris S. Constantinescu, PhD; Aaron Miller, MD; Tracy De Angelis, MD; Marcelo Matiello, MD; Bruce A. C. Cree, MD, PhD, MCR

Arch Neurol. 2008;65(11):1443-1448. Published online September 8, 2008 (doi:10.1001/archneur.65.11.noc80069).

Background  Neuromyelitis optica (NMO) is an uncommon, life-threatening inflammatory demyelinating disorder. Recently, much has become known about its immunopathogenesis. However, optimal treatments, with expected outcomes, have not been established.

Objective  To evaluate the use and efficacy of rituximab for treating NMO.

Design  Retrospective multicenter case series of NMO patients treated with rituximab.

Setting  Seven tertiary medical centers in the United States and England.

Patients  Twenty-five patients (including 2 children), 23 of whom experienced relapses despite use of other drugs before rituximab. Extended follow-up of 7 previously reported patients is included.

Interventions  Infusions of rituximab at median intervals of 8 months.

Main Outcome Measures  Annualized relapse rate and disability (expressed as Expanded Disability Status Scale score).

Results  At a median follow-up of 19 months, the median annualized posttreatment relapse rate was lower than the pretreatment rate (0 [range 0-3.2] vs 1.7 [range, 0.5-5] relapses, P < .001). Disability improved or stabilized in 20 of 25 patients (80%, P = .02). Two patients died during the follow-up period, 1 owing to a brainstem relapse and 1 owing to suspected septicemia. Infections were reported in 20% of patients.

Conclusions  In NMO, treatment with rituximab appears to reduce the frequency of attacks, with subsequent stabilization or improvement in disability.

Author Affiliations: Mayo Clinic, Rochester, Minnesota (Drs Jacob, Weinshenker, and Matiello); The Walton Centre, Liverpool, England (Drs Jacob and Boggild); University of California–San Francisco, San Francisco (Mr Violich and Dr Cree); State University of New York, Stony Brook (Drs McLinskey and Krupp); Mellen Center, Cleveland Clinic, Cleveland, Ohio (Dr Fox); Mayo Clinic, Scottsdale, Arizona (Dr Wingerchuk); Queens' Medical Centre, Nottingham, England (Dr Constantinescu); and Mount Sinai Hospital, New York, New York (Drs Miller and De Angelis).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

RELATED ARTICLE

This Month in Archives of Neurology
Arch Neurol. 2008;65(11):1415-1416.
FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

The borderland of neuromyelitis optica
Matthews et al.
PN 2009;9:335-340.
ABSTRACT | FULL TEXT  

Pathologic and immunologic profiles of a limited form of neuromyelitis optica with myelitis
Yanagawa et al.
Neurology 2009;73:1628-1637.
ABSTRACT | FULL TEXT  

Review: Identifying patient subtypes in multiple sclerosis and tailoring immunotherapy: challenges for the future
De Jager
Therapeutic Advances in Neurological Disorders 2009;2:369-377.
ABSTRACT  

Distinctive retinal nerve fibre layer and vascular changes in neuromyelitis optica following optic neuritis
Green and Cree
J. Neurol. Neurosurg. Psychiatry 2009;80:1002-1005.
ABSTRACT | FULL TEXT  

Treatment of Neuromyelitis Optica With Mycophenolate Mofetil: Retrospective Analysis of 24 Patients
Jacob et al.
Arch Neurol 2009;66:1128-1133.
ABSTRACT | FULL TEXT  

Diagnosis of Neuromyelitis Spectrum Disorders: Comparative Sensitivities and Specificities of Immunohistochemical and Immunoprecipitation Assays
McKeon et al.
Arch Neurol 2009;66:1134-1138.
ABSTRACT | FULL TEXT  

Nineteen Episodes of Recurrent Myelitis in a Woman With Neuromyelitis Optica and Systemic Lupus Erythematosus
Nasir et al.
Arch Neurol 2009;66:1160-1163.
ABSTRACT | FULL TEXT