Prolonged Remission in Neuromyelitis Optica Following Cessation of Rituximab Treatment

J Child Neurol. 2015 Sep;30(10):1366-70. doi: 10.1177/0883073814553974. Epub 2014 Nov 10.

Abstract

Neuromyelitis optica is an autoimmune disease characterized by acute episodes of transverse myelitis and optic neuritis. Several small, open-label studies suggest rituximab, a monoclonal antibody against CD20, prevents relapses in neuromyelitis optica; however, there is little consensus on timing or duration of treatment. Here we report four patients with severe relapsing neuromyelitis optica who were stabilized on rituximab and, after discontinuing treatment, continued to experience prolonged remission of their disease. Remission ranged from 4.5 to 10.5 years total, including 3 to 9 years off all therapies. The patients had sustained clinical responses despite normal B-lymphocyte levels and, in at least 2 patients, continued seropositivity for aquaporin-4 antibodies. These cases suggest that rituximab may induce prolonged remission in certain neuromyelitis optica patients, and they highlight the need for further elucidation of rituximab's mechanism in neuromyelitis optica.

Keywords: CNS demyelinating disease; neuromyelitis optica; rituximab.

Publication types

  • Case Reports

MeSH terms

  • Aquaporin 4 / metabolism
  • Child
  • Child, Preschool
  • Female
  • Humans
  • Immunologic Factors / administration & dosage*
  • Male
  • Middle Aged
  • Neuromyelitis Optica / drug therapy*
  • Neuromyelitis Optica / physiopathology*
  • Remission Induction
  • Rituximab / administration & dosage*

Substances

  • AQP4 protein, human
  • Aquaporin 4
  • Immunologic Factors
  • Rituximab