Rituximab appears to have efficacy in and neuromyelitis optica spectrum disorder (NMOSD) and oligodendrocyte glycoprotein antibody-associated disorders (MOGADs), however due to its narrow safety profile, it should be used with caution, according to a recently published article in the Journal of Neurology, Neurosurgery, and Psychiatry.

Currently, there are few randomized studies focusing on MOGAD therapy; therefore, MOGAD therapeutic strategies are mostly guided by clinical experiences in the management of diseases such as NMOSD. However, fundamental differences in the physiopathology of both entities result in different relapse risks. It is vital to acknowledge these differences when assessing therapeutic options.

Rituximab has been successfully used to prevent relapse in patients with NMOSD; previous studies suggest this drug could not be as effective in preventing MOGAD relapse. Due to the scarce evidence on the subject, the authors aimed to compare the efficacy of rituximab in NMOSD and MOGAD through a meta-analysis. 


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Efficacy was defined as the ability to reduce the annualized relapse rate (ARR) and improve neurological disability, as assessed by the Expanded Disability Status Scale (EDSS). The meta-analysis included 32 studies of patients with MOGAD. 

The researchers assessed patients treated with rituximab, as indicated in studies published between 2012 and 2021. The studies were selected from MEDLINE, Cochrane, Central, Register of Controlled Trials, and Clinicaltrials.gov. Results were later compared to those of a similar meta-analysis, including patients with NMOSD.

Results showed that rituximab has significant efficacy in reducing ARR and improving neurological disability quantified by EDSS. Furthermore, statistical analysis revealed that ARR reduction appeared to be correlated with the mean time from symptom onset to treatment initiation, thus advocating early use of rituximab in those patients.

The authors noted that compared to patients with NMOSD, ARR reduction seemed less impressive, attributing the difference to higher baseline ARR in patients with NMOSD. They also suggest that baseline ARR notwithstanding, rituximab could have similar efficacy in both conditions.

Approximately 12% of patients presented with adverse effects, with over 20% of them presenting with severe complications such as neutropenia/late onset neutropenia after rituximab treatment and interstitial lung disease.

“The potential risks and benefits of long-term treatment with RTX in MOGAD should be carefully evaluated, especially early after disease onset since approximately 50% of patients will maintain a monophasic disease course,” the authors concluded.

Reference

Spagni G, Sun B, Monte G, et al. Efficacy and safety of rituximab in myelin oligodendrocyte glycoprotein antibody-associated disorders compared with neuromyelitis optica spectrum disorder: a systematic review and meta-analysis. J Neurol Neurosurg Psychiatry. Published online October 25, 2022. doi:10.1136/jnnp-2022-330086