Rituximab as first-line therapy in neuromyelitis optica: efficiency and tolerability

J Neurol. 2015 Oct;262(10):2329-35. doi: 10.1007/s00415-015-7852-y. Epub 2015 Jul 21.


Neuromyelitis optica (NMO) is a life-threatening disease without any validated treatment strategy. Recent retrospective studies suggested the efficacy of B cell depletion without any distinction between first-line or rescue therapy. To assess whether rituximab as first-line therapy in NMO could efficiently control the occurrence of relapses. A retrospective analysis of NMO patients from NOMADMUS network found 32 patients receiving rituximab as first-line therapy. Main measures were number of relapse-free patients, changes in the annualized relapse rate (ARR), and changes in the EDSS. Tolerance was reported. At baseline, NMO patients were 45 ± 12.1 years old, with a sex ratio of 5.4, and 87.5 % of them had AQP4 antibodies. The median disease duration was 6.5 months (1-410), the mean EDSS was 5.8 ± 2.4 and the mean ARR was 3.8 ± 4.3. After rituximab with a mean follow-up of 28.7 ± 21 months, twenty-seven patients (84.3 %) were relapse free. Patients presented a 97 % decrease of ARR (p = 0.00001). EDSS decreased significantly to 3.9 ± 2.6 (p = 0.01). No relevant side effect was noted. New retrospective data are presented on RTX use in NMOSD. When used as first-line therapy RTX is highly effective and well tolerated.

Keywords: Aquaporin 4; B Cell depletion; Immunosuppression; Neuromyelitis optica; Relapse free; Rituximab.

MeSH terms

  • Adult
  • Female
  • Follow-Up Studies
  • Humans
  • Immunologic Factors / administration & dosage
  • Immunologic Factors / adverse effects
  • Immunologic Factors / pharmacology*
  • Male
  • Middle Aged
  • Neuromyelitis Optica / drug therapy*
  • Outcome Assessment, Health Care*
  • Recurrence
  • Rituximab / administration & dosage
  • Rituximab / adverse effects
  • Rituximab / pharmacology*


  • Immunologic Factors
  • Rituximab