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  Long-term follow-up of patients with neuromyelitis optica after repeated therapy with rituximab

Pellkofer, H. L., Krumbholz, M., Berthele, A., Hemmer, B., Gerdes, L. A., Havla, J., et al. (2011). Long-term follow-up of patients with neuromyelitis optica after repeated therapy with rituximab. Neurology, 76(15), 1310-1315.

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Pellkofer, H. L.1, Author
Krumbholz, M.2, Author           
Berthele, A.1, Author
Hemmer, B.1, Author
Gerdes, L. A.1, Author
Havla, J.1, Author
Bittner, R.2, Author           
Canis, M.1, Author
Meinl, E.2, Author           
Hohlfeld, R.2, Author           
Kuempfel, T.2, Author           
Affiliations:
1[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., ou_persistent22              
2Department: Neuroimmunology / Wekerle, MPI of Neurobiology, Max Planck Society, ou_1113547              

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 Abstract: 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

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Language(s): eng - English
 Dates: 2011-04
 Publication Status: Published in print
 Pages: -
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 Table of Contents: -
 Rev. Type: Peer
 Identifiers: eDoc: 563250
ISI: 000289407100008
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Title: Neurology
  Alternative Title : Neurology
Source Genre: Journal
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Publ. Info: PHILADELPHIA : LIPPINCOTT WILLIAMS & WILKINS
Pages: - Volume / Issue: 76 (15) Sequence Number: - Start / End Page: 1310 - 1315 Identifier: ISSN: 0028-3878