PMID- 37086634
OWN - NLM
STAT- MEDLINE
DCOM- 20230619
LR  - 20230619
IS  - 2211-0356 (Electronic)
IS  - 2211-0348 (Linking)
VI  - 74
DP  - 2023 Jun
TI  - Effectiveness of rituximab versus oral immunosuppressive therapies in 
      neuromyelitis optica spectrum disorder in a racially diverse cohort of subjects: 
      A single-center retrospective study.
PG  - 104718
LID - S2211-0348(23)00222-5 [pii]
LID - 10.1016/j.msard.2023.104718 [doi]
AB  - BACKGROUND: Neuromyelitis optica spectrum disorder (NMOSD) is an autoimmune, 
      inflammatory disorder characterized by severe relapses and high level of 
      disability. In clinical trials of NMOSD, Black patients are under-represented, < 
      12%, compared to a relatively high prevalence of NMSOD in this population, 
      10/100,000. Despite the higher prevalence of NMOSD in Black and Asian patients, 
      there is limited knowledge of the effectiveness of disease modifying treatments 
      across racially diverse groups. OBJECTIVE: To assess the effectiveness of 
      rituximab and oral immunosuppressive agents in a cohort of NMOSD patients, the 
      majority of whom are Black, in a real-world, clinical setting. METHODS: A 
      single-center retrospective study was conducted at the University of Chicago 
      Medical Center. INCLUSION CRITERIA: (1) diagnosis according to the 2015 
      International Panel for NMO Diagnosis (IPND) Criteria, (2) positive 
      anti-aquaporin-4 antibodies on ELISA or cell-based tests, (3) initiation of 
      immunosuppressant therapy within 5 years of disease onset, (4) first-line 
      treatment with rituximab, mycophenolate (MMF), or azathioprine (AZA). Patients 
      with negative anti-AQP4 titers were excluded. Kaplan-Meier survival analysis was 
      used to estimate proportion of relapse-free patients following initiation of 
      first line immunosuppressive therapy. A Cox proportional hazards regression model 
      assessed the association of risk of relapsing with first-line immunosuppressive 
      treatments with and without adjustments of pre-specified factors (age at disease 
      onset, duration of disease, sex, race, CNS location of relapse). RESULTS: 7 of 29 
      patients (24%) receiving rituximab experienced a relapse within the first 3 years 
      of treatment vs. 13 of 23 patients (57%) receiving either AZA or MMF. Within the 
      first 6 months of treatment, 2 (6.9%) patients treated with rituximab experienced 
      a relapse vs. 7 (30.4%) patients treated with either MMF or AZA. In the 29 
      patients treated with rituximab, the 1-year and 3-year proportion of relapse-free 
      patients was 88.8% and 70.9%. For the 23 patients treated with either AZA or MMF, 
      the 1-year and 3-year proportion of relapse-free patients was 69.5% and 38.7%. In 
      the univariate analysis, the risk of relapse was significantly higher in patients 
      treated with AZA or MMF compared to those treated with rituximab (hazard ratio 
      [HR] of 2.48 [0.99 - 6.21]; p = 0.046). CONCLUSION: In this real-world study 
      involving a majority of Black NMOSD patients, rituximab was relatively more 
      effective in preventing relapses within 3 years of therapy initiation than AZA 
      and MMF. Rituximab remains an effective option for treating NMOSD, especially 
      when there are delays in treatment due to access and economic issues associated 
      with newer treatments.
CI  - Copyright (c) 2023 The Authors. Published by Elsevier B.V. All rights reserved.
FAU - Dresser, Laura
AU  - Dresser L
AD  - MS & Neuromuscular Center of Excellence, Tampa, FL, United States of America.
FAU - Chaar, Widad Abou
AU  - Chaar WA
AD  - Department of Neurology, The University of Chicago, Chicago, IL, United States of 
      America.
FAU - Reder, Anthony T
AU  - Reder AT
AD  - Department of Neurology, The University of Chicago, Chicago, IL, United States of 
      America.
FAU - Abuaf, Amanda Frisosky
AU  - Abuaf AF
AD  - Department of Neurology, The University of Wisconsin, Madison, WI, United States 
      of America.
FAU - Cipriani, Veronica P
AU  - Cipriani VP
AD  - Department of Neurology, The University of Chicago, Chicago, IL, United States of 
      America.
FAU - Javed, Adil
AU  - Javed A
AD  - Department of Neurology, The University of Chicago, Chicago, IL, United States of 
      America. Electronic address: ajaved@uchicagomedicine.org.
LA  - eng
PT  - Journal Article
DEP - 20230416
PL  - Netherlands
TA  - Mult Scler Relat Disord
JT  - Multiple sclerosis and related disorders
JID - 101580247
RN  - 4F4X42SYQ6 (Rituximab)
RN  - HU9DX48N0T (Mycophenolic Acid)
RN  - 0 (Immunosuppressive Agents)
RN  - MRK240IY2L (Azathioprine)
RN  - 0 (Aquaporin 4)
SB  - IM
MH  - Humans
MH  - Rituximab/therapeutic use
MH  - *Neuromyelitis Optica
MH  - Retrospective Studies
MH  - Mycophenolic Acid
MH  - Immunosuppressive Agents/therapeutic use
MH  - Azathioprine/therapeutic use
MH  - Immunosuppression Therapy
MH  - Recurrence
MH  - Aquaporin 4
OTO - NOTNLM
OT  - Azathioprine
OT  - Mycophenolate
OT  - NMOSD
OT  - Relapse freedom
OT  - Rituximab
COIS- Declaration of Competing Interest AJ has received honoraria and consulting fees 
      from Biogen, Serono, Genentech-Roche, BMS, and TG therapeutics. VPC has received 
      compensation for consulting and/or speaking engagements from EMD Serono, Sanofi 
      and Genentech Roche. ATR has received unrestricted grant support from 
      Roche/Genentech. AFA has received fellowship funding from Roche/Genentech. LD and 
      WAC have nothing to disclose.
EDAT- 2023/04/23 00:41
MHDA- 2023/06/19 13:08
CRDT- 2023/04/22 18:06
PHST- 2022/11/19 00:00 [received]
PHST- 2023/04/11 00:00 [revised]
PHST- 2023/04/12 00:00 [accepted]
PHST- 2023/06/19 13:08 [medline]
PHST- 2023/04/23 00:41 [pubmed]
PHST- 2023/04/22 18:06 [entrez]
AID - S2211-0348(23)00222-5 [pii]
AID - 10.1016/j.msard.2023.104718 [doi]
PST - ppublish
SO  - Mult Scler Relat Disord. 2023 Jun;74:104718. doi: 10.1016/j.msard.2023.104718. 
      Epub 2023 Apr 16.