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Treatment of MOG-IgG-associated disorder with rituximab: an international study of 121 patients

Lookup NU author(s): Dr Rob Forsyth

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This is the authors' accepted manuscript of an article that has been published in its final definitive form by Elsevier BV, 2020.

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Abstract

Objective: To assess the effect of anti-CD20 B-cell depletion with rituximab (RTX) on relapse rates in myelin oligodendrocyte glycoprotein antibody-associated disorder (MOGAD). Methods: Retrospective review of RTX-treated MOGAD patients from 29 centres in 13 countries. The primary outcome measure was change in relapse rate after starting rituximab (Poisson regression model). Results: Data on 121 patients were analysed, including 30 (24.8%) children. Twenty/121 (16.5%) were treated after one attack, of whom 14/20 (70.0%) remained relapse-free after median (IQR) 11.2 (6.3-14.1) months. The remainder (101/121, 83.5%) were treated after two or more attacks, of whom 53/101 (52.5%) remained relapse-free after median 12.1 (6.3-24.9) months. In this ‘relapsing group’, relapse rate declined by 37% (95%CI=19-52%, p<0.001) overall, 63% (95%CI=35-79%, p=0.001) when RTX was used first line (n=47), and 26% (95%CI=2-44%, p=0.038) when used after other steroid-sparing immunotherapies (n=54). Predicted 2-year relapse-free survival was 55% for first-line RTX therapy, and 18% for second-/third-line therapy. Circulating CD19 + B-cells were suppressed to <1% of total circulating lymphocyte population at the time of 45/57 (78.9%) relapses. Conclusion: RTX reduced relapse rates in MOGAD. However, many patients continued to relapse despite apparent B-cell depletion. Prospective controlled studies are needed to validate these results.


Publication metadata

Author(s): Whittam DH, Cobo-Calvo A, Lopez-Chiriboga AS, Pardo S, Gornall M, Cicconi S, Brandt A, Berek K, Berger T, Jelcic I, Gombolay A, Oliveira LM, Callegaro D, Kaneko K, Misu T, Capobianco M, Gibbons E, Karthikeayan V, Brochet B, Audoin B, Mathey G, Laplaud D, Thouvenot E, Cohen M, Tourbah A, Maillart E, Ciron K, Deschamps R, Biotti D, Rostasy K, Neuteboom R, Hemingway C, Forsyth R, Matiello M, Webb S, Hunt D, Murray K, Hacohen Y, Lim M, Leite MI, Palace J, Solomon T, Lutterotti A, Fujihara K, Nakshima I, Bennett JL, Pandit L, Chitnis T, Weinshenker BG, Wildemann B, Sato DK, Kim S-H, Huda S, Kim HJ, Reindl M, Levy M, Jarius S, Tenembaum S, Friedemann P, Pittock S, Marignier R, Jacob A

Publication type: Article

Publication status: Published

Journal: Multiple Sclerosis and Related Disorders

Year: 2020

Volume: 44

Print publication date: 01/09/2020

Online publication date: 02/06/2020

Acceptance date: 02/06/2020

Date deposited: 11/06/2020

ISSN (print): 2211-0348

ISSN (electronic): 2211-0356

Publisher: Elsevier BV

URL: https://doi.org/10.1016/j.msard.2020.102251

DOI: 10.1016/j.msard.2020.102251


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