Rethinking rituximab in neuroimmunology: Real-world efficacy, cost-effectiveness, and long-term remission

Abstract

This short communication reviews the long-term use of rituximab (RTX) in neuroimmunological disease and presents a case of chronic inflammatory demyelinating polyneuropathy (CIDP) achieving sustained remission after rituximab therapy. A 10-year retrospective review of 40 patients treated with RTX at a South African quaternary neurology unit demonstrated consistent efficacy, durable safety, and significant cost savings compared to conventional immunotherapies. In addition, a patient with refractory childhood-onset CIDP achieved complete and enduring remission following RTX administration, with normal functional recovery and discontinuation of all immunotherapy. This report highlights the clinical and economic rationale for RTX as a long-term disease-modifying therapy in immune-mediated neurological disorders and argues for its earlier integration into standard treatment protocols, especially in resource-limited settings.

Keywords: Autoimmune encephalitis (AIE); Autoimmune nodopathies (AIN); Chronic inflammatory demyelinating polyneuropathy (CIDP); Combined central and peripheral demyelination (CCPD); Dermatomyositis; Intravenous immunoglobulin (IVIG); Multiple sclerosis (MS); Myasthenia Gravis (MG); Neuromyelitis Optica spectrum disorders (NMOSD); Plasma exchange (PE); Polymyositis; Rituximab; Stiff person syndrome.