Researchers discovered that rituximab demonstrated sufficient efficiency and safety for the treatment of neuromyelitis optica spectrum disorder (NMOSD), as published in Therapeutic Advances in Neurological Disorders. This makes it a suitable candidate for the first-line treatment of NMOSD.

Rituximab was accepted to treat NMOSD in 2005 because it therapeutically targets antibody-producing B cells and the role of astrocyte aquaporin 4-immunoglobulin G in the pathogenesis of NMOSD. Although studies have emerged investigating its safety profile, few have analyzed the rates of specific adverse events of rituximab or compared its safety profile with that of other treatments.

“Thus, to address these knowledge shortfalls, we conducted this systematic review and meta-analysis to evaluate the rates of adverse events associated with rituximab and the risks of adverse events compared with other NMOSD treatments,” Wang et al wrote.

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“We included all randomized controlled trials, non-randomized controlled trials, cohort studies, case-control studies (considered as studies with control groups), and case series with subjects that met 2015, 2006, or 1999 [neuromyelitis optica]/NMOSD diagnostic consensus criteria, with no restriction of age, race, sex, or nationality,” they said in conducting their research.

In addition, participants with NMOSD had to be treated by any dose of rituximab, with or without glucocorticoids or other forms of therapy.

“Rates of patients with any adverse events, any serious adverse events, infusion-related adverse events, any infection, respiratory infection, urinary infection, and death were 28.57%, 5.66%, 27.01%, 17.36%, 4.76%, 4.76%, and 0.17%, respectively,” Wang et al wrote on the results from their study.

Very low-quality evidence suggested that the risk ratios of any adverse events and any infections of rituximab were comparable to that of azathioprine; risk ratios of any adverse events of rituximab were comparable to mycophenolate mofetil. 

“Overall, we might infer that the adverse events of rituximab for NMOSD, which are mild or moderate, have non-high incidences with mostly lower risks compared to other traditional immunosuppressants, and thus could be prevented or treated well,” the authors concluded.

“Consequently, considering the efficacy and safety of rituximab, it could be advised as a first-line treatment for NMOSD.”


Wang H, Zhou J, Li Y, et al. Adverse events of rituximab in neuromyelitis optica spectrum disorder: a systematic review and meta-analysis. Ther Adv Neurol Disord. Published online December 17, 2021. doi:10.1177/17562864211056710