Rituximab was relatively more effective than azathioprine and mycophenolate in preventing neuromyelitis optica spectrum disorder (NMOSD) relapses within 3 years after the start of treatment, according to the results of a real-world study involving a majority of Black patients. 

“Rituximab remains an effective option for treating NMOSD,” the authors of the study wrote, “especially when there are delays in treatment due to access and economic issues associated with newer treatments.”

Black patients are under-represented in NMOSD clinical trials even though the disease is relatively common among these patients. Moreover, the effectiveness of disease-modifying therapies across different racial groups is not well understood.

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Here, a team of researchers led by Adil Javed, MD, PhD, from the Department of Neurology at the University of Chicago in Illinois conducted a single-center retrospective study to evaluate the efficacy of rituximab and oral immunosuppressants in a group of patients who were mostly Black.

All patients were positive for anti-aquaporin-4 (AQP-4) antibodies and had initiated immunosuppressant therapy within 5 years of the start of the disease either with rituximab, mycophenolate, or azathioprine as first-line therapy. 

The results showed that 7 of the 29 patients (24%) who received rituximab had a relapse within the first 3 years of treatment. This proportion was 57% for patients receiving mycophenolate or azathioprine (13 of 23 patients). 

When they looked at the first 6 years after the start of treatment, the researchers found that a smaller proportion of patients treated with any immunosuppressant experienced relapse. More precisely, only 2 patients treated with rituximab (6.9% of all patients treated with the medication) had a relapse compared to 7 (30.4%) patients treated with mycophenolate or azathioprine. 

The 1-year proportion of relapse-free patients treated with rituximab was 88.8%, while the 3-year proportion of relapse-free patients given this treatment was 70.9%.

These proportions were 69.5% and 38.7% for the 1- and 3-year proportions of relapse-free patients treated with mycophenolate or azathioprine, respectively.

Using statistical analyses, the researchers calculated that the risk of relapse was significantly higher among patients treated with mycophenolate or azathioprine than in those who received rituximab.

The study is published in Multiple Sclerosis and Related Disorders


Dresser L, Chaar WA, Reder AT, Abuaf AF, Cipriani VP, Javed A. Effectiveness of rituximab versus oral immunosuppressive therapies in neuromyelitis optica spectrum disorder in a racially diverse cohort of subjects: a single-center retrospective study. Mult Scler Relat Disord. Published online April 16, 2023. doi:10.1016/j.msard.2023.104718