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          Institute: MPI für Neurobiologie     Collection: Neuroimmunology     Display Documents

ID: 563250.0, MPI für Neurobiologie / Neuroimmunology
Long-term follow-up of patients with neuromyelitis optica after repeated therapy with rituximab
Authors:Pellkofer, H. L.; Krumbholz, M.; Berthele, A.; Hemmer, B.; Gerdes, L. A.; Havla, J.; Bittner, R.; Canis, M.; Meinl, E.; Hohlfeld, R.; Kuempfel, T.
Date of Publication (YYYY-MM-DD):2011-04
Title of Journal:Neurology
Journal Abbrev.:Neurology
Issue / Number:15
Start Page:1310
End Page:1315
Review Status:Peer-review
Audience:Not Specified
Abstract / Description:Background: Neuromyelitis optica (NMO) is a severe autoimmune disease targeting optic nerves and spinal cord. The monoclonal anti-CD20 B-cell antibody rituximab is an emerging therapeutic option in NMO. However, neither long-term efficacy or safety of rituximab, nor the correlation between B-cell counts, B-cell fostering cytokines, aquaporin-4 antibodies (AQP4-ab), and disease activity in NMO, have been investigated prospectively. Methods: We performed a prospective long-term cohort study of 10 patients with NMO who were treated up to 5 times with rituximab as a second-line therapy. Clinical examinations, B-cell counts, and serum concentrations of BAFF (B-cell activating factor of the TNF family; also called TNFSF13b), APRIL (a proliferation-inducing ligand; also called TNFSF13), AQP4-ab, and immunoglobulin levels were measured every 3 months. Results: Repeated treatment with rituximab led to sustained clinical stabilization in most patients with NMO. Disease activity correlated with B-cell depletion, but not clearly with AQP4-ab or levels of APRIL. BAFF levels increased after application of rituximab and indicated persisting efficacy of the drug but did not correlate with disease activity. Overall, rituximab was well-tolerated even after up to 5 consecutive treatment courses; however, we observed several severe adverse reactions. Conclusion: Our data indicate that long-term therapy with rituximab is effective in NMO as a second-line therapy and has an acceptable safety profile. Retreatment with rituximab should be applied before reappearance of circulating B cells. Classification of evidence: This study provides Class IV evidence that repeated doses of rituximab result in stabilization in most patients. Neurology (R) 2011;76:1310-1315
External Publication Status:published
Document Type:Article
Version Comment:Automatic journal name synchronization
Affiliations:MPI für Neurobiologie/Neuroimmunology (Wekerle)/Clinical Neuroimmunology (Hohlfeld)
External Affiliations:[Pellkofer, H. L.; Krumbholz, M.; Gerdes, L. A.; Havla, J.; Bittner, R.; Meinl, E.; Hohlfeld, R.; Kuempfel, T.] Univ Munich, Inst Clin Neuroimmunol, D-81377 Munich, Germany.; [Pellkofer, H. L.] Univ Munich, Dept Neurol, D-81377 Munich, Germany.; [Canis, M.] Univ Munich, Dept Otorhinolaryngol Head & Neck Surg, D-81377 Munich, Germany.; [Berthele, A.; Hemmer, B.] Tech Univ Munich, Dept Neurol, Munich, Germany.
Identifiers:ISI:000289407100008 [ID No:1]
ISSN:0028-3878 [ID No:2]
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