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Rituximab De-escalation in Patients With Neuromyelitis Optica Spectrum Disorder

dc.rights.licenseopenen_US
dc.contributor.authorDEMUTH, Stanislas
dc.contributor.authorCOLLONGUES, Nicolas
hal.structure.identifierNeurocentre Magendie : Physiopathologie de la Plasticité Neuronale [U1215 Inserm - UB]
dc.contributor.authorAUDOIN, Bertrand
dc.contributor.authorAYRIGNAC, Xavier
dc.contributor.authorBOURRE, Bertrand
dc.contributor.authorCIRON, Jonathan
dc.contributor.authorCOHEN, Michaël
dc.contributor.authorDESCHAMPS, Romain
dc.contributor.authorDURAND-DUBIEF, Françoise
dc.contributor.authorMAILLART, Elisabeth
dc.contributor.authorPAPEIX, Caroline
hal.structure.identifierNeurocentre Magendie : Physiopathologie de la Plasticité Neuronale [U1215 Inserm - UB]
dc.contributor.authorRUET, Aurelie
dc.contributor.authorZEPHIR, Helene
dc.contributor.authorMARIGNIER, Romain
dc.contributor.authorDE SEZE, Jerome
dc.date.accessioned2024-03-04T15:34:26Z
dc.date.available2024-03-04T15:34:26Z
dc.date.issued2023-07-25
dc.identifier.urihttps://oskar-bordeaux.fr/handle/20.500.12278/188569
dc.description.abstractEnBackground and ObjectivesExit strategies such as de-escalations have not been evaluated for rituximab in patients with neuromyelitis optica spectrum disorder (NMOSD). We hypothesized that they are associated with disease reactivations and aimed to estimate this risk.MethodsWe describe a case series of real-world de-escalations from the French NMOSD registry (NOMADMUS). All patients met the 2015 International Panel for NMO Diagnosis (IPND) diagnostic criteria for NMOSD. A computerized screening of the registry extracted patients with rituximab de-escalations and at least 12 months of subsequent follow-up. We searched for 7 de-escalation regimens: scheduled discontinuations or switches to an oral treatment after single infusion cycles, scheduled discontinuations or switches to an oral treatment after periodic infusions, de-escalations before pregnancies, de-escalations after tolerance issues, and increased infusion intervals. Rituximab discontinuations motivated by inefficacy or for unknown purposes were excluded. The primary outcome was the absolute risk of NMOSD reactivation (one or more relapses) at 12 months. AQP4+ and AQP4- serotypes were analyzed separately.ResultsWe identified 137 rituximab de-escalations between 2006 and 2019 that corresponded to a predefined group: 13 discontinuations after a single infusion cycle, 6 switches to an oral treatment after a single infusion cycle, 9 discontinuations after periodic infusions, 5 switches to an oral treatment after periodic infusions, 4 de-escalations before pregnancies, 9 de-escalations after tolerance issues, and 91 increased infusion intervals. No group remained relapse-free over the whole de-escalation follow-up (mean: 3.2 years; range: 0.79-9.5), except pregnancies in AQP+ patients. In all groups combined and within 12 months, reactivations occurred after 11/119 de-escalations in patients with AQP4+ NMOSD (9.2%, 95% CI [4.7-15.9]), from 0.69 to 10.0 months, and in 5/18 de-escalations in patients with AQP4- NMOSD (27.8%, 95% CI [9.7-53.5]), from 1.1 to 9.9 months. © American Academy of Neurology.
dc.description.sponsorshipObservatoire Français de la Sclérose en Plaquesen_US
dc.language.isoENen_US
dc.title.enRituximab De-escalation in Patients With Neuromyelitis Optica Spectrum Disorder
dc.title.alternativeNeurologyen_US
dc.typeArticle de revueen_US
dc.identifier.doi10.1212/WNL.0000000000207443en_US
dc.subject.halSciences du Vivant [q-bio]/Neurosciences [q-bio.NC]en_US
dc.identifier.pubmed37290967en_US
bordeaux.journalNeurologyen_US
bordeaux.pageE438-E450en_US
bordeaux.volume101en_US
bordeaux.hal.laboratoriesNeurocentre Magendie - U1215en_US
bordeaux.issue4en_US
bordeaux.institutionUniversité de Bordeauxen_US
bordeaux.institutionINSERMen_US
bordeaux.institutionBordeaux INP
bordeaux.institutionCNRS
bordeaux.institutionINRAE
bordeaux.institutionArts et Métiers
bordeaux.teamRelations glie-neuroneen_US
bordeaux.peerReviewedouien_US
bordeaux.inpressnonen_US
hal.identifierhal-04488723
hal.version1
hal.date.transferred2024-03-04T15:34:29Z
hal.popularnonen_US
hal.audienceInternationaleen_US
hal.exporttrue
dc.rights.ccPas de Licence CCen_US
bordeaux.COinSctx_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.jtitle=Neurology&rft.date=2023-07-25&rft.volume=101&rft.issue=4&rft.spage=E438-E450&rft.epage=E438-E450&rft.au=DEMUTH,%20Stanislas&COLLONGUES,%20Nicolas&AUDOIN,%20Bertrand&AYRIGNAC,%20Xavier&BOURRE,%20Bertrand&rft.genre=article


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