The use of B-cell-depleting agents as a treatment for neuromyelitis optica spectrum disorder (NMOSD) and MOG-associated diseases (MOGAD) has become more common, but there has yet to be a consensus on the optimal dose and frequency of administration.
A new study published in Neurology and Therapy investigated the effect of a personalized rituximab (RTX) treatment approach based on CD27-positive B-cell monitoring on inffusin rates, efficacy, and safety.
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The study highlighted that CD27-positive B-cell monitoring, compared to B-cell monitoring, is more effective regarding safety and efficacy. Moreover, the lower infusion number effectively reduces the treatment burden and risk of infectious events, the study authors noted.
The researchers included 19 patients with NMOSD and MOGAD treated with RTX at a tertiary multiple sclerosis center in San Luigi University Hospital in Orbassano, Italy, between January 2008 and 2022. The included patients were required to have a diagnosis of NMOSD or MOGAD based on the 2015 diagnostic criteria and have reached at least 1 year of follow-up after CD27 monitoring initiation.
Moreover, all patients were divided according to their disease phenotype (NMOSD and MOGAD) and received RTX induction with 2 1000mg infusions 15 days apart every 6 months and maintenance infusion according to B-cell monitoring. Monthly follow-up of patients was conducted for 2 years with CD19 and CD27 positive B-cell evaluation.
According to study results, the annualized relapse rate (ARR) 1 year prior to RTX initiation was 2.37, which reduced to 0.08 in the following years after RTX start. Moreover, no significant difference was observed in ARR before and after the initiation of CD27 monitoring. Furthermore, the median inter-dose time was 8.80 months (range 5.78–14.23) before CD27 monitoring which elevated to 15.93 months (range 8.56–35.37) after CD27 monitoring. The study found no adverse events (AEs) during the treatment and follow-up.
“Our findings suggest that in our cohort CD27-positive B-cell-based RTX reinfusion regimen was able to reduce the number of RTX reinfusions relative to CD19-positive B-cell monitoring, with comparable efficacy and safety profile,” the authors remarked. The authors suggested that evaluating FCGR3A genetic polymorphisms during the assessment of RTX efficacy can improve individualized and effective treatment to a greater extent.
NMOSD is an inflammatory autoimmune disease affecting the central nervous system and characterized by severe attacks of transverse myelitis and/or optic neuritis. Most NMOSD patients test positive for water channel aquaporin-4 autoantibodies (AQP4-IgG), while a minority have antibodies against myelin oligodendrocyte glycoprotein (MOG-IgG).
B-cell-depleting agents, including RTX, are effective in treating NMOSD and, to a lesser extent, MOGAD. These agents are administered via different treatment regimens, including fixed time-point infusions or cell monitoring-based reinfusion regimens.
Cell monitoring-based reinfusion regimens are classified into either maintenance regimens based on monitoring CD19-positive or blood CD27-positive B-cells. In NMOSD, a regimen based on blood CD27-positive B-cell dosage has been adopted to tailor RTX redosing, with consistent results.
Reference
Bruschi N, Malentacchi M, Malucchi S, et al. Tailoring rituximab according to CD27-positive B-cell versus CD19-positive B-Cell monitoring in Neuromyelitis Optica Spectrum Disorder and MOG-associated disease: results from a single-center study. Neurol Ther. Published online May 11, 2023. doi:10.1007/s40120-023-00481-w
