Multiple sclerosis and related disorders · 2025
Efficacy of a fixed-interval, body surface area-adjusted rituximab regimen in Singaporean patients with CNS inflammatory demyelinating diseases.
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Tan Jeanne May May, Sivalingam Thanushiree, Wong Daniel Yi Jie, Tye Janis Siew Noi, Aw Amelia Yun Yi, Siew Rachel Wan En, Peng Xuejuan, Tan Kevin, Saffari Seyed Ehsan, Yeo Tianrong
Аннотация
INTRODUCTION: Rituximab is frequently used as an off-label treatment for Multiple Sclerosis (MS), Aquaporin-4 Antibody Neuromyelitis Optica Spectrum Disorder (AQP4-Ab NMOSD), and Myelin Oligodendrocyte Glycoprotein Antibody-associated Disease (MOGAD). However, the optimal dosage is still unknown - an important question as those receiving the drug are at an increased risk of infections.
METHODS: We retrospectively investigated the clinical and immunocytological efficacy of rituximab in a cohort of patients with MS, AQP4-Ab NMOSD, and MOGAD treated at the National Neuroscience Institute in Singapore. All subjects adhered to a fixed 6-monthly, body surface area (BSA)-adjusted dose (375 mg/m2) rituximab maintenance regimen, after 2 induction doses of 1000 mg given 2 weeks apart. Annualised relapse rates (ARR) before and after rituximab treatment and time to B cell repopulation were calculated.
RESULTS: In total, 80 patients were included (43 MS, 34 AQP4-Ab NMOSD, and 3 MOGAD). Overall ARR in years 1 and 2 of therapy were 0.132 and 0.184, respectively, representing an 83 % to 88 % risk reduction compared to the ARR (1.088) in the 12 months prior to rituximab initiation. Eight patients (10 %) relapsed, 5 within 6 months of rituximab induction. Approximately one-third of patients (35.9 %) demonstrated B cell repopulation at least once during maintenance treatment, with higher BSA (p = 0.0300) and BMI (p = 0.0438), particularly obesity (p = 0.034), being predictive of earlier repopulation after adjusting for sex.
CONCLUSIONS: Despite B cell repopulation in a substantial proportion of patients, our 6-monthly, BSA-adjusted regimen resulted in low relapse rates, similar to what was observed in previous studies using higher doses.
METHODS: We retrospectively investigated the clinical and immunocytological efficacy of rituximab in a cohort of patients with MS, AQP4-Ab NMOSD, and MOGAD treated at the National Neuroscience Institute in Singapore. All subjects adhered to a fixed 6-monthly, body surface area (BSA)-adjusted dose (375 mg/m2) rituximab maintenance regimen, after 2 induction doses of 1000 mg given 2 weeks apart. Annualised relapse rates (ARR) before and after rituximab treatment and time to B cell repopulation were calculated.
RESULTS: In total, 80 patients were included (43 MS, 34 AQP4-Ab NMOSD, and 3 MOGAD). Overall ARR in years 1 and 2 of therapy were 0.132 and 0.184, respectively, representing an 83 % to 88 % risk reduction compared to the ARR (1.088) in the 12 months prior to rituximab initiation. Eight patients (10 %) relapsed, 5 within 6 months of rituximab induction. Approximately one-third of patients (35.9 %) demonstrated B cell repopulation at least once during maintenance treatment, with higher BSA (p = 0.0300) and BMI (p = 0.0438), particularly obesity (p = 0.034), being predictive of earlier repopulation after adjusting for sex.
CONCLUSIONS: Despite B cell repopulation in a substantial proportion of patients, our 6-monthly, BSA-adjusted regimen resulted in low relapse rates, similar to what was observed in previous studies using higher doses.