Rituximab dosing and monitoring strategies in neuromyelitis optica patients: creating strategies for therapeutic success

Background: Neuromyelitis optica (NMO) is an autoimmune condition that predominantly causes severe optic neuritis and transverse myelitis. Rituximab therapy has dramatically improved patient care, but standardized dosing regimens and guidelines are lacking. Objectives: The objective of this study wa...

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Bibliographic Details
Published in:Multiple sclerosis 2012-07, Vol.18 (7), p.1022-1026
Main Authors: Greenberg, Benjamin M, Graves, Donna, Remington, Gina, Hardeman, Paula, Mann, Martha, Karandikar, Nitin, Stuve, Olaf, Monson, Nancy, Frohman, Elliot
Format: Article
Language:English
Subjects:
Antibodies, Monoclonal, Murine-Derived - administration & dosage
Antigens, CD19 - immunology
B-Lymphocytes - drug effects
B-Lymphocytes - immunology
Biological and medical sciences
Cell Count
Degenerative and inherited degenerative diseases of the nervous system. Leukodystrophies. Prion diseases
Female
Humans
Immunologic Factors - administration & dosage
Medical sciences
Middle Aged
Multiple sclerosis and variants. Guillain barré syndrome and other inflammatory polyneuropathies. Leukoencephalitis
Neurology
Neuromyelitis Optica - drug therapy
Neuromyelitis Optica - immunology
Retrospective Studies
Rituximab
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Summary:Background: Neuromyelitis optica (NMO) is an autoimmune condition that predominantly causes severe optic neuritis and transverse myelitis. Rituximab therapy has dramatically improved patient care, but standardized dosing regimens and guidelines are lacking. Objectives: The objective of this study was to define a rituximab dosing strategy for NMO patients that achieves the lowest rate of relapses. Methods: This was a retrospective chart review of patients treated with various doses of rituximab. Results: Combining data from the NMO and multiple sclerosis (MS) patients, identified that the mean number of days after a 100 mg dose of rituximab until the CD19 population was greater than 2% was 99 days (standard deviation 36, range 43–172). When allowed to rise, the mean number of days after a 1000 mg dose of rituximab until the CD19 population was greater than 2% was 184 (standard deviation 72, range 52–288). The median number of days until a CD19 percentage of 2% was achieved was 133 days in the 100 mg dosing arm and 259 days in the 1000 mg dosing arm. Analysis of the survival curves via both the Mantel–Cox log-rank test and the Wilcoxon test determined that the difference between medial survival for 100 and 1000 mg doses was statistically significant with p-values
ISSN:1352-4585
1477-0970
DOI:10.1177/1352458511432896