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Treatment of MOG-IgG-associated disorder with rituximab: an international study of 121 patients

Authors

  • D.H. Whittam
  • A. Cobo-Calvo
  • A.S. Lopez-Chiriboga
  • S. Pardo
  • M. Gornall
  • S. Cicconi
  • A. Brandt
  • K. Berek
  • T. Berger
  • I. Jelcic
  • G. Gombolay
  • L.M. Oliveira
  • D. Callegaro
  • K. Kaneko
  • T. Misu
  • M. Capobianco
  • E. Gibbons
  • V. Karthikeayan
  • B. Brochet
  • B. Audoin
  • G. Mathey
  • D. Laplaud
  • E. Thouvenot
  • M. Cohen
  • A. Tourbah
  • E. Maillart
  • J. Ciron
  • R. Deschamps
  • D. Biotti
  • K. Rostasy
  • R. Neuteboom
  • C. Hemingway
  • R. Forsyth
  • M. Matiello
  • S. Webb
  • D. Hunt
  • K. Murray
  • Y. Hacohen
  • M. Lim
  • M.I. Leite
  • J. Palace
  • T. Solomon
  • A. Lutterotti
  • K. Fujihara
  • I. Nakashima
  • J.L. Bennett
  • L. Pandit
  • T. Chitnis
  • B.G. Weinshenker
  • B. Wildemann
  • D.K. Sato
  • S.H. Kim
  • S. Huda
  • H.J. Kim
  • M. Reindl
  • M. Levy
  • S. Jarius
  • S. Tenembaum
  • F. Paul
  • S. Pittock
  • R. Marignier
  • A. Jacob

Journal

  • Multiple Sclerosis and Related Disorders

Citation

  • Mult Scler Relat Disord 44: 102251

Abstract

  • OBJECTIVE: To assess the effect of anti-CD20 B-cell depletion with rituximab (RTX) on relapse rates in myelin oligodendrocyte glycoprotein antibody-associated disorder (MOGAD). METHODS: Retrospective review of RTX-treated MOGAD patients from 29 centres in 13 countries. The primary outcome measure was change in relapse rate after starting rituximab (Poisson regression model). RESULTS: Data on 121 patients were analysed, including 30 (24.8%) children. Twenty/121 (16.5%) were treated after one attack, of whom 14/20 (70.0%) remained relapse-free after median (IQR) 11.2 (6.3-14.1) months. The remainder (101/121, 83.5%) were treated after two or more attacks, of whom 53/101 (52.5%) remained relapse-free after median 12.1 (6.3-24.9) months. In this 'relapsing group', relapse rate declined by 37% (95%CI=19-52%, p<0.001) overall, 63% (95%CI=35-79%, p = 0.001) when RTX was used first line (n = 47), and 26% (95%CI=2-44%, p = 0.038) when used after other steroid-sparing immunotherapies (n = 54). Predicted 1-year and 2-year relapse-free survival was 79% and 55% for first-line RTX therapy, and 38% and 18% for second-/third-line therapy. Circulating CD19(+)B-cells were suppressed to <1% of total circulating lymphocyte population at the time of 45/57 (78.9%) relapses. CONCLUSION: RTX reduced relapse rates in MOGAD. However, many patients continued to relapse despite apparent B-cell depletion. Prospective controlled studies are needed to validate these results.


DOI

doi:10.1016/j.msard.2020.102251