Early treatment with rituximab could prevent the worsening of long-term disability in patients with neuromyelitis optica spectrum disorder (NMOSD), according to a new study published in the Journal of Neurology, Neurosurgery, and Psychiatry. This is especially true for patients with early to middle-age of disease onset, women, and those with severe attacks.

To assess the effect of initiating rituximab early in patients with NMOSD, a team of researchers from Korea conducted a multicenter retrospective study on 145 patients with the disease. All patients, the majority (88.3%) of whom were female were positive for aquaporin-4 antibodies and all were being treated with rituximab. Almost all patients (98.6%) were being treated with immunosuppressants or oral steroids before rituximab.

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The mean age of onset of the disease among the patients was 39.5 and the mean duration of the disease was 121 months.

Statistical analyses showed that the Expanded Disability Status Scale (EDSS) score was associated with the time that passed between the onset of the first symptoms to the start of rituximab treatment. 

The EDSS score was also associated with the maximum EDSS score before the initiation of rituximab treatment. 

In patients who were younger than age 50, female, and had a maximum EDSS score of at least 6 before rituximab treatment, the time between the onset of the first symptoms and the start of rituximab treatment was also associated with the EDSS score.

“Earlier initiation of rituximab treatment is effective for favourable long-term outcomes in patients with NMOSD”, the researchers concluded, “especially for early-age to middle-age onset and in female patients and patients with severe disability”.

“Further studies are needed to clarify [the] effectiveness of rituximab as first-line treatment compared with second-line treatment and to develop predictive biomarkers for the response to rituximab”.

Rituximab is an anti-CD20 monoclonal antibody that works by depleting B-cells and has been shown to be effective in preventing relapses in NMOSD.


Park SY, Kwon YN, Kim S, et al. Early rituximab treatment reduces long-term disability in aquaporin-4 antibody-positive neuromyelitis optica spectrum. J Neurol Neurosurg Psychiatry. Published online June 2, 2023. doi:10.1136/jnnp-2022-330714