Support for rituximab therapy in neuromyelitis optica spectrum disorders
medwireNews: Rituximab therapy reduces the frequency of disease relapses and neurological disability in patients with neuromyelitis optica spectrum disorders (NMOSDs), a systematic review and meta-analysis shows.
However, an adverse event rate of 26%, including seven deaths, means caution is necessary when prescribing the drug as a first-line therapy.
“[U]ntil the results of controlled trials become available, the risk-benefit ratio of rituximab treatment should be carefully assessed in individual patients with NMOSDs”, warn Raffaele Iorio (“A. Gemelli,” Catholic University, Rome, Italy).
They reviewed 46 studies involving 438 patients aged 32 years on average at treatment initiation.
The average reduction in the annualised relapse rate ratio after rituximab therapy, based on 25 studies, was 0.79. And the average reduction in the Expanded Disability Status Scale (EDSS) score, reported in 18 studies, was 0.64.
The researchers note in JAMA Neurology that the inclusion of observational studies resulted in high heterogeneity, particularly for the EDSS score, but suggest that this is likely to be due to variability of sample sizes, after finding only disease duration correlated significantly with this efficacy measure.
A total of 114 patients experienced adverse effects, mostly minor in severity and related to infusion (10.3%) and infection (9.1%). Persistent leukopenia developed in 20 (4.6%) patients, two (0.5%) had posterior reversible encephalopathy and seven (1.6%) patients died, but in the case of the latter, the researchers suggest this may reflect the natural history of NMOSDs, which are associated with a mortality rate of up to 12%.
“[T]he safety profile suggests caution in prescribing rituximab as a first-line therapy”, say the researchers.
They comment on the importance of NMOSD therapy in reducing or preventing disease attacks “because each disease relapse causes an accumulation of disability.”
The team concludes that their analysis “provides sufficient data to support the efficacy of rituximab therapy in reducing relapse rates and disability in patients with NMOSDs.”
By Lucy Piper
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