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

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Item Type:	Article
Title:	Treatment of MOG-IgG-associated disorder with rituximab: an international study of 121 patients
Creators Name:	Whittam, D.H., Cobo-Calvo, A., Lopez-Chiriboga, A.S., Pardo, S., Gornall, M., Cicconi, S., Brandt, A., Berek, K., Berger, T., Jelcic, I., Gombolay, G., Oliveira, L.M., Callegaro, D., Kaneko, K., Misu, T., Capobianco, M., Gibbons, E., Karthikeayan, V., Brochet, B., Audoin, B., Mathey, G., Laplaud, D., Thouvenot, E., Cohen, M., Tourbah, A., Maillart, E., Ciron, J., Deschamps, R., Biotti, D., Rostasy, K., Neuteboom, R., Hemingway, C., Forsyth, R., Matiello, M., Webb, S., Hunt, D., Murray, K., Hacohen, Y., Lim, M., Leite, M.I., Palace, J., Solomon, T., Lutterotti, A., Fujihara, K., Nakashima, I., Bennett, J.L., Pandit, L., Chitnis, T., Weinshenker, B.G., Wildemann, B., Sato, D.K., Kim, S.H., Huda, S., Kim, H.J., Reindl, M., Levy, M., Jarius, S., Tenembaum, S., Paul, F., Pittock, S., 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
ISSN:	2211-0348
Publisher:	Elsevier
Volume:	44
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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