An infusion of 100 mg of rituximab per week for 3 weeks is optimal for treating neuromyelitis optica spectrum disorder (NMOSD), according to a systematic review and meta-analysis published in Multiple Sclerosis and Related Disorders.

According to the article, a regimen of 100 mg per week for 3 weeks was found to be the best of those tested across 17 studies in terms of change in annual recurrence rate (ARR), Expanded Disability Status Scale (EDSS) score, and the number of patients free of relapse.

“This meta-analysis combined safety, efficacy, and cost, which suggest that 100 mg/w for 3 consecutive weeks may be the suitable dose of rituximab for patients of NMOSD with a low risk of adverse events,” the authors said.

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In regard to ARR, the dosage regimen led to a mean difference of -1.79 (95% CI, -3.18 to -.39; P =.01) before and after treatment. The mean difference for EDSS score was -1.35 (95% CI, -1.5 to -1.19; P <.00001) with this dosage. The number of patients free of relapse was also the best with this treatment regimen, with a risk ratio of 24.61 (95% CI, 5.11 to 118.55; P <.0001).

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No serious adverse events were recorded during the studies that included the dosage of 100 mg per week for 3 weeks. A few adverse events (AEs) were reported, however, including allergic reactions and infections.

Another dosage regimen of two 1000-mg doses given 2 weeks apart was also found to be effective in reducing EDSS score and ARR. The higher rates of adverse events and serious adverse events and the increased cost make it a less attractive option, however.

“Low doses of rituximab at 100 mg/w for 3 weeks were significantly effective in reducing ARR and disability rates, with a lower financial burden on patients or the public health system, and a lower risk of adverse events than other doses,” the authors concluded.

The meta-analysis included 17 studies and 576 participants with NMOSD. Five different dosage regimens were reported, including 100 mg per week for 3 weeks, 375 mg/m2 once, 500 mg per week for 4 weeks, 375 mg/m2 weekly for 4 weeks, and 1000 mg given twice 2 weeks apart.


Wei K, Nie Q, Zhu Y, Lu H, Xue Q, Chen G. Different doses of rituximab for the therapy of neuromyelitis optica spectrum disorder: a systematic review and meta-analysis. Mult Scler Relat Disord. Published online August 18, 2022. doi:10.1016/j.msard.2022.104127