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Letter
Less frequent rituximab retreatment maintains remission of neuromyelitis optica spectrum disorder, following long-term rituximab treatment
  1. Su-Hyun Kim,
  2. Yeseul Kim,
  3. Gayoung Kim,
  4. Na Young Park,
  5. Hyun-Min Jang,
  6. Hyun-June Shin,
  7. Jae-Won Hyun,
  8. Ho Jin Kim
  1. Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang, South Korea
  1. Correspondence to Dr Ho Jin Kim, Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang 410-769, South Korea; hojinkim{at}ncc.re.kr

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Introduction

Rituximab, a chimeric monoclonal antibody that selectively targets CD20+ B cells, has exhibited robust efficacy and an acceptable safety profile in neuromyelitis optica spectrum disorder (NMOSD).1–3 Previously, we reported that the therapeutic response of B cell depletion varied among 100 patients with NMOSD, which resulted from multiple factors including Fc gamma polymorphism, and that monitoring CD27+ memory B cell appears to improve treatment outcomes via individualised treatment.2 Our treatment strategy has also proven to effectively prevent relapse at a lower cumulative dose, compared with the fixed maintenance therapy every 6 months, in a French cohort.4 Currently, we have a group of patients with NMOSD who have undergone long-term rituximab treatment for more than 7 years. We found that retreatment interval became significantly prolonged over time when we targeted depletion of memory B cells. Here, we analysed clinical outcomes and changes in B cell reconstitution over time, following long-term repeated rituximab treatment.

Methods

Through December 2017, sixty-eight patients with NMOSD had been treated with rituximab for at least 7 years. Twenty-one patients who had been treated with mitoxantrone, prior to rituximab, were excluded; the remaining 47 patients were included. Written informed consent was obtained from all patients. After induction therapy, patients received a single infusion of rituximab, at a dose of 375 mg/m2, as maintenance therapy; this was performed whenever the frequency of re-emerging CD27+ memory B cells in peripheral blood mononuclear cells (PBMC) exceeded 0.05% as revealed by flow cytometry for the initial 2 years, and, subsequently, when the frequency exceeded …

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