Rituximab With or Without Chemotherapy for Anti-MAG Neuropathy: A Retrospective Multicenter Real-World Study.
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Emilien Delmont, Pascal Cintas, Céline Tard, José Boucraut, Laurent Magy, Simon Frachet, Céline Labeyrie, Andoni Echaniz-Laguna, Nicolas Noel, Juliette Svahn, Antoine Pegat, Françoise Bouhour, Florent Cluse, Angela Puma, Armelle Magot, Laure Farnault, Thérèse Aurran Schleinitz, Thierry Gendre, Violaine Planté-Bordeneuve, Alice Dormeuil, Julien Cassereau, Jean-Baptiste Chanson, Martial Mallaret, Tanya Stojkovic, Jean-Baptiste Noury, Guillaume Taieb, Jean-Philippe Camdessanché, Louis Poncet-Megemont, Aude-Marie Grapperon, Etienne Fortanier, Shahram Attarian
Аннотация
METHODS: Patients with anti-MAG antibody titers > 10 000 Buhlmann titer units (BTUs) were included. Treatment response was defined as an improvement of ≥ 1 point in the Overall Neuropathy Limitation Scale (ONLS) compared to baseline. Propensity score matching was used to account for differences in baseline characteristics between treatment groups.
RESULTS: A total of 230 patients were included: 150 received RTX and 80 received ICT. Mean follow-up was 4 years (range, 1-20 years). One year after treatment, clinical improvement occurred in 61/147 (41%) patients treated with RTX and 39/78 (50%) treated with ICT (OR = 1.4 [0.8-2.5] p = 0.3). At last follow-up, clinical improvement occurred in 55/150 (37%) patients treated with RTX and 31/80 (39%) treated with ICT (OR = 1.1 [0.6-1.9] p = 0.8). Propensity score matching yielded similar results. Among ICT regimens, dexamethasone-RTX-cyclophosphamide was associated with the highest response rate. RTX induction, 1 g days 1 and 15, seemed superior to four-weekly infusions. Adverse events were more frequent with ICT than with RTX (28% vs. 15%; OR = 2.20 [1.07-4.54], p = 0.02).
INTERPRETATION: In this cohort, adding chemotherapy to RTX was not associated with greater long-term improvement, despite a higher rate of adverse events. Prospective controlled studies are needed.