Journal of clinical neurology (Seoul, Korea) · 2025
Evaluating Rituximab Failure Rates in Neuromyelitis Optica Spectrum Disorder: A Nationwide Real-World Study From South Korea.
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Kim Su-Hyun, Min Ju-Hong, Kim Sung-Min, Lee Eun-Jae, Lim Young-Min, Shin Ha Young, Kwon Young Nam, Sohn Eunhee, Kim Sooyoung, Park Min Su, Nam Tai-Seung, Yoon Byeol-A, Kim Jong Kuk, Shin Kyong Jin, Kim Yoo Hwan, Seok Jin Myoung, Bong Jeong Bin, Kim Sohyeon, Seok Hung Youl, Oh Sun-Young, Kwon Ohyun, Kim Sunyoung, Lee Sukyoon, Kim Nam-Hee, Cho Eun Bin, Kang Sa-Yoon, Oh Seong-Il, Bae Jong Seok, Ahn Suk-Won, Kim Ki Hoon, Kang You-Ri, Ju Woohee, Choo Seung Ho, Chung Yeon Hak, Hyun Jae-Won, Kim Ho Jin
Аннотация
BACKGROUND AND PURPOSE: Treatments for neuromyelitis optica spectrum disorder (NMOSD) such as eculizumab, ravulizumab, satralizumab, and inebilizumab have significantly advanced relapse prevention, but they remain expensive. Rituximab is an off-label yet popular alternative that offers a cost-effective solution, but its real-world efficacy needs better quantification for guiding the application of newer approved NMOSD treatments (ANTs). This study aimed to determine real-world rituximab failure rates to anticipate the demand for ANTs and aid in resource allocation.
METHODS: We conducted a nationwide retrospective study involving 605 aquaporin-4-antibody-positive NMOSD patients from 22 centers in South Korea that assessed the efficacy and safety of rituximab over a median follow-up of 47 months.
RESULTS: The 605 patients treated with rituximab included 525 (87%) who received continuous therapy throughout the follow-up period (median=47 months, interquartile range=15-87 months). During this period, 117 patients (19%) experienced at least 1 relapse. Notably, 68 of these patients (11% of the total cohort) experienced multiple relapses or at least 1 severe relapse. Additionally, 2% of the patients discontinued rituximab due to adverse events, which included severe infusion reactions, neutropenia, and infections.
CONCLUSIONS: This study has confirmed the efficacy of rituximab in treating NMOSD, as evidenced by an 87% continuation rate among patients over a 4-year follow-up period. Nevertheless, the occurrence of at least one relapse in 19% of the cohort, including 11% who experienced multiple or severe relapses, and a 2% discontinuation rate due to adverse events highlight the urgent need for alternative therapeutic options.
METHODS: We conducted a nationwide retrospective study involving 605 aquaporin-4-antibody-positive NMOSD patients from 22 centers in South Korea that assessed the efficacy and safety of rituximab over a median follow-up of 47 months.
RESULTS: The 605 patients treated with rituximab included 525 (87%) who received continuous therapy throughout the follow-up period (median=47 months, interquartile range=15-87 months). During this period, 117 patients (19%) experienced at least 1 relapse. Notably, 68 of these patients (11% of the total cohort) experienced multiple relapses or at least 1 severe relapse. Additionally, 2% of the patients discontinued rituximab due to adverse events, which included severe infusion reactions, neutropenia, and infections.
CONCLUSIONS: This study has confirmed the efficacy of rituximab in treating NMOSD, as evidenced by an 87% continuation rate among patients over a 4-year follow-up period. Nevertheless, the occurrence of at least one relapse in 19% of the cohort, including 11% who experienced multiple or severe relapses, and a 2% discontinuation rate due to adverse events highlight the urgent need for alternative therapeutic options.