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

Autor:	Park SY; Department of Neurology, Korea Cancer Center Hospital, Seoul, Korea (the Republic of)., Kwon YN; Department of Neurology, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea (the Republic of)., Kim S; Department of Neurology, Ulsan University Hospital College of Medicine, Ulsan, Korea (the Republic of)., Kim SH; Department of Neurology, Hanyang University College of Medicine, Seoul, Korea (the Republic of)., Kim JK; Department of Neurology, Dong-A University College of Medicine, Busan, Korea (the Republic of)., Kim JS; Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea (the Republic of)., Nam TS; Department of Neurology, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Korea (the Republic of)., Min YG; Department of Neurology, Seoul National University College of Medicine, Seoul, Korea (the Republic of)., Park KS; Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea (the Republic of)., Park JS; Department of Neurology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, Korea (the Republic of)., Seok JM; Department of Neurology, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea (the Republic of)., Sung JJ; Department of Neurology, Seoul National University College of Medicine, Seoul, Korea (the Republic of)., Sohn E; Department of Neurology, Chungnam National University, College of Medicine, Daejeon, Korea (the Republic of)., Shin KJ; Department of Neurology, Haeundae Paik Hospital, Inje University, Busan, Korea (the Republic of)., Shin JH; Department of Neurology, Pusan National University Yangsan Hospital, Yangsan, Korea (the Republic of)., Shin HY; Department of Neurology, Yonsei University College of Medicine, Seoul, Korea (the Republic of)., Oh SI; Department of Neurology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea (the Republic of)., Oh J; Department of Neurology, Konkuk University School of Medicine, Seoul, Korea (the Republic of)., Yoon BA; Department of Neurology, Dong-A University College of Medicine, Busan, Korea (the Republic of)., Lee S; Department of Neurology, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, Korea (the Republic of)., Lee JM; Department of Neurology, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Korea (the Republic of)., Lee HL; Department of Neurology, Korea University College of Medicine, Seoul, Korea (the Republic of)., Choi K; Department of Neurology, Konkuk University School of Medicine, Seoul, Korea (the Republic of)., Huh SY; Department of Neurology, Kosin University College of Medicine, Busan, Korea (the Republic of)., Jang MJ; Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Korea (the Republic of)., Min JH; Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)., Kim BJ; Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of) sueh916@gmail.com bjkim@skku.edu., Kim SM; Department of Neurology, Seoul National University College of Medicine, Seoul, Korea (the Republic of) sueh916@gmail.com bjkim@skku.edu.
Jazyk:	angličtina
Zdroj:	Journal of neurology, neurosurgery, and psychiatry [J Neurol Neurosurg Psychiatry] 2023 Oct; Vol. 94 (10), pp. 800-805. Date of Electronic Publication: 2023 Jun 02.
DOI:	10.1136/jnnp-2022-330714
Abstrakt:	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. Competing Interests: Competing interests: S-MK has lectured, consulted and received honoraria from Bayer Schering Pharma, Genzyme, Merck Serono and UCB; received a grant from the National Research Foundation of Korea and the Korea Health Industry Development Institute Research. S-MK and KSP are associate editors of the Journal of Clinical Neurology. S-MK, KSP, Seoul National University and Seoul National University Hospital have transferred the technology of the flow cytometric autoantibody assay to the EONE Laboratory, Korea. Byoung Joon Kim; honoraria/consulting fees (Biogen, Genzyme, Merck, Sanofi, Astellas, Merk); member of advisory boards (Astellas, Korean FDA). (© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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