Abstract Details

Title Long-term Efficacy and Safety of Rituximab in Neuromyelitis Optica Spectrum Disorder and MOG Antibody Disease

Topic Autoimmune Neurology

Presentation(s) P15 - Poster Session 15 (5:30 PM-6:30 PM)

Poster/Presentation
Number 9-006

Background Rituximab is used widely for relapse prevention in NMOSD and MOGAD, however data regarding the efficacy and safety of long-term rituximab use in these conditions is limited.

Objective To characterize the long-term efficacy and safety of rituximab treatment in neuromyelitis optica spectrum disorder (NMOSD) and myelin oligodendrocyte glycoprotein (MOG)-IgG associated disease (MOGAD).

Design/Methods

We performed a retrospective chart review of patients with aquaporin-4 IgG seropositive NMOSD or MOGAD followed at the Johns Hopkins Neuromyelitis Optica Clinic and included patients who had received at least one dose of rituximab. We identified 111 NMOSD and 23 MOGAD patients who fulfilled eligibility criteria.

Results

Median duration of treatment with rituximab for the NMOSD subjects was 3.7 years (IQR: 1.9 to 7.5) and for the MOGAD subjects was 2.1 years (IQR: 0.9 to 4.2). The annualized relapse rate (ARR) decreased after initiation of rituximab treatment, as compared to the pre-treatment period, in both NMOSD (median ARR: pre-treatment 0.85, post-treatment: 0; p<0.001) and MOGAD (median ARR: pre-treatment 1.8, post-treatment 0.45; p=0.01). Relapses on rituximab treatment occurred in 36 NMOSD (32%) and 15 MOGAD (65%) patients. The vast majority of NMOSD treatment failures (28/36; 78%) occurred either within the initial 3 months after starting rituximab or in the setting of missed rituximab doses and/or peripheral B cell reconstitution, whereas in MOGAD this was the case in a smaller proportion of treatment failures (3/15;20%). Infections requiring hospitalization occurred in 17/134 (13%) and hypogammaglobulinemia developed in 18/97 (19%) patients. Median rituximab treatment duration before hypogammaglobulinemia onset was 5.14 years [IQR; 3.0 to 7.7].

Conclusions

This study supports that rituximab is highly effective for relapse prevention in AQP4-IgG seropositive NMOSD, especially in the absence of gaps in treatment and/or B cell reconstitution. However, severe infections and hypogammaglobulinemia occurred in a significant proportion of patients, highlighting the need for close monitoring for infectious complications.

Authors/Disclosures
Eleni Vasileiou, MD (Mount Sinai) PRESENTER	Dr. Vasileiou has nothing to disclose.
Paula Barreras, MD (Cedars-Sinai Medical Center)	The institution of Dr. Barreras has received research support from Foundation for Sarcoidosis Research. The institution of Dr. Barreras has received research support from American Academy of Neurology.
Angeliki Filippatou, MD (Johns Hopkins University School of Medicine)	Dr. Filippatou has nothing to disclose.
Kathryn Fitzgerald, PhD (Johns Hopkins University)	The institution of Dr. Fitzgerald has received research support from NIH. The institution of Dr. Fitzgerald has received research support from National MS Society.
Michael Levy, MD, PhD, FAAN (Massachusetts General Hospital/Harvard Medical School)	Dr. Levy has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Mitsubishi Pharma. Dr. Levy has received personal compensation in the range of $500-$4,999 for serving as a Consultant for UCB Pharma. Dr. Levy has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Sanofi. Dr. Levy has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion. Dr. Levy has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Horizon. Dr. Levy has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genentech. Dr. Levy has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Elsevier. Dr. Levy has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Various law firms. The institution of Dr. Levy has received research support from National Institutes Health.
Ellen M. Mowry, MD, FAAN (Johns Hopkins University)	Dr. Mowry has received personal compensation in the range of $500-$4,999 for serving as a Consultant for BeCareLink, LLC. The institution of Dr. Mowry has received research support from Biogen. The institution of Dr. Mowry has received research support from Genentech. Dr. Mowry has received publishing royalties from a publication relating to health care.
Peter A. Calabresi, MD, FAAN (Johns Hopkins University)	Dr. Calabresi has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Novartis. Dr. Calabresi has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Lilly. Dr. Calabresi has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Idorsia. An immediate family member of Dr. Calabresi has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for MyMD. Dr. Calabresi has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Myelin Repair Foundation. The institution of Dr. Calabresi has received research support from Genentech. Dr. Calabresi has received publishing royalties from a publication relating to health care. Dr. Calabresi has received personal compensation in the range of $500-$4,999 for serving as a Study Section Member with NIH. Dr. Calabresi has received personal compensation in the range of $500-$4,999 for serving as a Grant reveiwer with Myelin Repair Foundation. Dr. Calabresi has received personal compensation in the range of $500-$4,999 for serving as a Speaker for CME with NYAS. Dr. Calabresi has received personal compensation in the range of $500-$4,999 for serving as a Speaker with Academic CME.
Elias S. Sotirchos, MD (Johns Hopkins University)	Dr. Sotirchos has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genentech. Dr. Sotirchos has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion. Dr. Sotirchos has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Amgen. Dr. Sotirchos has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for TG Therapeutics. The institution of Dr. Sotirchos has received research support from National Institutes of Health. The institution of Dr. Sotirchos has received research support from National Multiple Sclerosis Society. The institution of Dr. Sotirchos has received research support from Sumaira Foundation. The institution of Dr. Sotirchos has received research support from Genentech. The institution of Dr. Sotirchos has received research support from UCB. The institution of Dr. Sotirchos has received research support from Astoria Biologica. The institution of Dr. Sotirchos has received research support from Ad Scientiam. The institution of Dr. Sotirchos has received research support from Alexion. The institution of Dr. Sotirchos has received research support from Corevitas. Dr. Sotirchos has received personal compensation in the range of $500-$4,999 for serving as a Ad Hoc Reviewer with National Institutes of Health.