Impact of rituximab on relapse rate and disability in neuromyelitis optica
Impact of rituximab on relapse rate and disability in neuromyelitis optica
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DOI：
10.1177/1352458511404586
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发表时间：
2011-10-01
影响因子：
5.8
通讯作者：
Sheremata, William A.
中科院分区：
文献类型：
--
作者：
Bedi, Gurdesh S.;Brown, Andrew D.;Sheremata, William A.
背景：视神经肌萎缩症（NMO）是一种严重的脱髓鞘疾病，常导致严重残疾。越来越多的证据表明其发病机制涉及体液机制。在没有批准的治疗的情况下，抗炎/免疫抑制剂药物已经凭经验使用了三十多年。最近的证据表明水通道蛋白4抗体在NMO发病机制中的作用，导致利妥昔单抗的使用，利妥昔单抗是一种靶向整个B细胞谱系上的CD 20表位的单克隆抗体。目的：评估利妥昔单抗对NMO复发率和残疾的影响。方法：这是IRB批准的对利妥昔单抗治疗的NMO患者的回顾性纵向研究。结果：我们确定了53例NMO患者，其中23例接受了利妥昔单抗治疗。这些患者（2例男性，21例女性）在诊断时的平均年龄为37.1 ± 14.6岁。23例接受利妥昔单抗治疗的患者中有8例为初治患者。所有23例患者计划在治疗开始后每6个月或12个月接受一次输注，至少随访6个月（中位数32.5个月，范围7-63个月）。中位复发率从1.87次复发/患者/年显著下降至0.0次复发/患者/年。所有患者的Kurtzke扩展残疾状态量表（EDSS）评分稳定或改善。利妥昔单抗的使用与NMO患者复发和残疾的显著减少相关。
Background: Neuromyelitis optica (NMO) is a severe demyelinating disease often leading to serious disability. Accumulating evidence now implicates humoral mechanisms in its pathogenesis. In the absence of an approved therapy, anti-inflammatory/immunosuppressant drugs have been used empirically for more than three decades. Recent evidence for a role of antibody to aquaporin-4 in the pathogenesis of NMO has led to the use of rituximab, a monoclonal antibody targeting the CD20 epitope on the entire B cell lineage.Objectives: To evaluate the impact of rituximab on the relapse rate and disability in NMO.Methods: This is an IRB approved retrospective longitudinal study of NMO patients treated with rituximab.Results: We identified 53 patients with NMO, 23 of whom had been treated with rituximab. These patients (2 males, 21 females) had a mean age of 37.1 +/- 14.6 years at the time of diagnosis. Eight of the 23 treated with rituximab were treatment naive. All 23 were scheduled to receive infusions every six or 12 months after treatment initiation with a minimum follow-up of six months (median 32.5 months, range 7-63 months). Median relapse rate declined significantly from 1.87 relapses/patient per year to 0.0 relapses/patient per year. Kurtzke Expanded Disability Status Scale (EDSS) scores stabilized or improved in all patients. Use of rituximab is associated with a significant reduction in relapses and disability in patents with NMO.