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

Item Type:Article
Title:Treatment of MOG-IgG-associated disorder with rituximab: an international study of 121 patients
Creators Name:Whittam, D.H. and Cobo-Calvo, A. and Lopez-Chiriboga, A.S. and Pardo, S. and Gornall, M. and Cicconi, S. and Brandt, A. and Berek, K. and Berger, T. and Jelcic, I. and Gombolay, G. and Oliveira, L.M. and Callegaro, D. and Kaneko, K. and Misu, T. and Capobianco, M. and Gibbons, E. and Karthikeayan, V. and Brochet, B. and Audoin, B. and Mathey, G. and Laplaud, D. and Thouvenot, E. and Cohen, M. and Tourbah, A. and Maillart, E. and Ciron, J. and Deschamps, R. and Biotti, D. and Rostasy, K. and Neuteboom, R. and Hemingway, C. and Forsyth, R. and Matiello, M. and Webb, S. and Hunt, D. and Murray, K. and Hacohen, Y. and Lim, M. and Leite, M.I. and Palace, J. and Solomon, T. and Lutterotti, A. and Fujihara, K. and Nakashima, I. and Bennett, J.L. and Pandit, L. and Chitnis, T. and Weinshenker, B.G. and Wildemann, B. and Sato, D.K. and Kim, S.H. and Huda, S. and Kim, H.J. and Reindl, M. and Levy, M. and Jarius, S. and Tenembaum, S. and Paul, F. and Pittock, S. and Marignier, R. and Jacob, A.
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.
Keywords:Myelin Oligodendrocyte Glycoprotein, MOG, Rituximab, Neuromyelitis Optica, Optic Neuritis
Source:Multiple Sclerosis and Related Disorders
Page Range:102251
Date:September 2020
Official Publication:https://doi.org/10.1016/j.msard.2020.102251
External Fulltext:View full text on PubMed Central
PubMed:View item in PubMed

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