Short communicationTransient increases in anti-aquaporin-4 antibody titers following rituximab treatment in neuromyelitis optica, in association with elevated serum BAFF levels
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Acknowledgements
This study was supported by KAKENHI (19209032 and 20390241) of The Ministry of Education, Culture, Sports, Science and Technology (MEXT) of Japan, and by the Health and Labor Sciences Research Grant on Intractable Diseases (Neuroimmunological Diseases) from the Ministry of Health, Labor and Welfare of Japan. BACC received grant support from the NINDS (K-23 NS0-48869) and Genentech.
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2020, Multiple Sclerosis and Related DisordersCitation Excerpt :If RTX is used following a relapse, concurrent use of oral steroids for at least 1 month, followed by tapering. This is because RTX treatment could be followed by relapses in the first month (Perumal et al., 2015), possibly because of induction of B-cell activating factor, thus resulting in a transient increase in AQP4-ab titers or lysis of B cells (Flanagan and Weinshenker, 2014; Perumal et al., 2015; Nakashima et al., 2011). Regardless of the number and severity of relapses among NMOSD patients after treatment starts, occurrences of relapses after at least six months of correct use of the specific treatment indicates that disease activity still persists and justifies modifying the therapeutic scheme to balance the risk and benefit.
Treatment of MOG-IgG-associated disorder with rituximab: An international study of 121 patients
2020, Multiple Sclerosis and Related DisordersCitation Excerpt :The validity of this adjustment is uncertain in MOGAD, but stems from experience in AQP4-IgG-NMOSD, where a lag time of 3–4 weeks to achieve relapse-preventing effect has been described, despite complete B-cell depletion within days of RTX infusion [Kim et al., 2013, Lindsey et al., 2012]. Relapse risk may in fact be paradoxically high during this lag period, [Perumal et al., 2015, Nakashima et al., 2011] but most consider this not to reflect truly RTX-refractory disease [Kimbrough et al., 2012]. An even greater delay to therapeutic effect is possible: Decline in relapse rate improved to 55% when relapses within three months of RTX initiation were excluded.
Safety and efficacy of rituximab in neuromyelitis optica spectrum disorders (RIN-1 study): a multicentre, randomised, double-blind, placebo-controlled trial
2020, The Lancet NeurologyCitation Excerpt :In our trial, to avoid an excessive risk of relapse and more precisely assess efficacy, we adopted a schedule of oral steroid tapering that was as close as possible to a clinical regimen used widely in Japan,30 although there is no standard clinical regimen of oral steroid tapering. Patients receiving oral steroids (5–30 mg/day) were eligible for our study; the steroid dose was fixed for 2 months after rituximab induction, because it can take approximately 2 months to achieve immunosuppressive effects by CD20 lymphocyte depletion.31 The oral steroid dose was then reduced gradually in a stepwise fashion (1–3 mg per visit, 10% reduction every 4 weeks) to 2–5 mg/day by the final visit.
Efficacy of different rituximab therapeutic strategies in patients with neuromyelitis optica spectrum disorders
2019, Multiple Sclerosis and Related Disorders