A new literature review and meta-analysis reports that the monoclonal antibody tocilizumab has a greater effect than rituximab on reducing Expanded Disability Status Scale (EDSS) score and annualized relapse rate (ARR) in patients with neuromyelitis optica spectrum disorder (NMOSD). The review, published in Multiple Sclerosis and Related Disorders, included 36 studies with 1010 patients, with a meta-analysis of 27 studies.

“Our meta-analysis shows that rituximab is beneficial in preventing relapse and improving disability,” the authors wrote. “This finding is similar to a recent network meta-analysis which has shown rituximab to be more efficacious than other previously used immunomodulators.”

The research team found that both rituximab and tocilizumab were effective in preventing relapses and improving disability, with tocilizumab having a greater effect on ARR and EDSS score. Tocilizumab also helped alleviate chronic intractable pain and fatigue. The authors speculate that the efficacy of tocilizumab could be due to its anti-inflammatory effect on interleukin-6-dependent processes.

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The review also found that other monoclonal antibodies—in particular satralizumab, eculizumab, and inebilizumab—were all safe and effective in aquaporin-4 antibody-positive cases. Screening for chronic hepatitis B is recommended before starting therapy.

Prospective, retrospective, cohort, and randomized controlled trials that reported ARR or EDSS score were included in the study. The most common adverse effects reported included infusion reactions and immunosuppressive effects of the drug, leading to an increased risk of cancer and infection.

Given that monoclonal antibodies are expensive and difficult to obtain, particularly in lower-income countries, the authors recommend that clinicians focus on the most effective and tolerable treatments while considering their price and availability.


Wang Y, Chang H, Zhang X, Yin L. Efficacy of rituximab in the treatment of neuromyelitis optica spectrum disorders: an update systematic review and meta-analysis. Mult Scler Relat Disord. 2021;50:102843. doi:10.1016/j.msard.2021.102843