Efficacy of rituximab in the treatment of neuromyelitis optica spectrum disorders: An update systematic review and meta -analysis

• Published in: Multiple sclerosis and related disorders Vol. 50; p. 102843
• Main Authors: Wang, Yupeng, Chang, Haoxiao, Zhang, Xinghu, Yin, Linlin
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.05.2021
• Subjects: Annualized relapse rate; Antibodies, Monoclonal; B-Lymphocytes; Expanded disability status scale; Female; Humans; Male; Meta-analysis; Neurology; Neuromyelitis Optica - drug therapy; Neuromyelitis optica spectrum disorders; Optic Nerve; Rituximab; Rituximab - therapeutic use; CYCL; ARR; RCT; CENTRAL; Rituximab; Annualized relapse rate; AZA; MeSH; Neuromyelitis optica spectrum disorders; Meta-analysis; MTX; SD; NMO; AQP4-Ab; RTX; Expanded disability status scale; EDSS; mitoxantrone; cyclophosphamide; Medical Subject Heading; neuromyelitis optica; randomized clinical trial; aquaporin-4 autoantibody; Cochrane Central Register of Controlled Trials; acetazolamide; standard deviation
• ISSN: 2211-0348; 2211-0356; 2211-0356
• DOI: 10.1016/j.msard.2021.102843

•Neuromyelitis optica is a serious autoimmune disease of the central nervous system.•The incidence of the disease in females is significantly higher than that in males.•Rituximab can effectively treat the disease (reduce the annual recurrence rate)•Rituximab can improve the degree of disability in patients with neuromyelitis optica. Neuromyelitis optica spectrum disorders (NMOSD) is an autoimmune astrocyte disease that mainly affects the optic nerve and spinal cord resulting in blindness or paralysis. Rituximab (RTX) is a chimeric monoclonal antibody directed against the surface antigen of CD20 on B lymphocytes and is an emerging treatment option in NMOSD. The present review aimed to conduct an update systematic review and meta-analysis for the efficacy of RTX in the treatment of NMOSD and analyze main factors affecting the efficacy of RTX. The following Medical Subject Heading (MeSH) and related entry terms are used to search English literature in PubMed, MEDLINE and CENTRAL databases, respectively. MeSH include: Neuromyelitis optic and Rituximab; entry terms include: NMO Spectrum Disorder, NMO Spectrum Disorders, Neuromyelitis Optica (NMO) Spectrum Disorder, Neuromyelitis Optica Spectrum Disorders, Devic Neuromyelitis Optica, Neuromyelitis Optica, Devic, Devic's Disease, Devic Syndrome, Devic's Neuromyelitis Optica, Neuromyelitis Optica (NMO) Spectrum Disorders, CD20 Antibody, Rituximab CD20 Antibody, Mabthera, IDEC-C2B8 Antibody, GP2013, Rituxan; (note: literature retrieval operators “AND” “OR” “NOT” are used to link MeSH with Entry Terms.) 54 studies were included in this systematic review and 29 studies were included in meta-analysis. The main efficacy indicators were the difference of the expanded disability status scale (EDSS) and annualized relapse rate (ARR) between before and after rituximab treatments. In 29 studies involving 732 patients (643 women, 84 men, 5 with unknown gender), the EDSS and ARR were reduced by an average of −0.57 (95%CI, −0.69 to −0.44), −1.57 (95%CI, −1.78 to −1.35), respectively. Our systematic review and update meta-analysis provide new evidences that RTX can effectively improve disability and reduce ARR ratio.