Contributions
Abstract: P1153
Type: Poster
Abstract Category: Therapy - disease modifying - 26 Immunomodulation/Immunosuppression
Introduction: Neuromyelitis optica spectrum disorders (NMOSD) are recurrent and disabling diseases with clinical attacks mainly involving optic nerves and the spinal cord. Azathioprine and mycophenolate mofetil are commonly recommended as first-line treatments, however a substantial percentage of patients do not show response to therapy. Rituximab is a monoclonal antibody directed against CD20 B-lymphocyte surface antigen, and is usually accepted that provides better disease stabilization than other therapies available to date. Although most studies adopt a treatment-to-target approach using peripheral blood B-cell monitoring, there is no defined protocol regarding retreatment strategies. Considering that flow cytometric analyses are not usually available in public health services in developing countries, we report our experience with antiAQP4 positive patients who received rituximab treatment without regular peripheral B-cell monitoring.
Methods: We performed a retrospective review of patients with NMOSD and positive AQP4 antibodies who received rituximab for at least six months. Rituximab was administered with an induction treatment of 1000mg infused twice during a 2-week interval. Most patients received a maintenance treatment of 500mg infused twice during a two-week interval every six months regardless of peripheral B-cell monitoring. Delayed retreatment was a frequent concern due to medication availability.
Results: 13 patients were included (mean age 41, F/M sex ratio 12/1). Mean prerituximab annualized relapse rate (ARR) was 1.79, and mean postrituximab ARR was 0.33 (P=0.0005). Of 13 patients, 8 (62%) showed marked reduction in the ARR (< 25% prerituxumab AAR). Median EDSS score was 7 (range 5-8) before rituximab treatment, and 8 (range 5-8) after rituximab treatment (P=0.75). A marked proportion (78%) of relapses occurred in periods of delayed retreatment.
Conclusion: Our 6-month reinfusion protocol is effective in reducing relapse risk, and may be considered as an option when B-cell monitoring is not available. Delayed retreatment should be avoided without regular peripheral B-cell monitoring.
Disclosure: Dr Pedro Henrique Bruel Torretta: nothing to disclose
Dr Samira Luíza Apóstolos Pereira received grants related to congress meetings and preceptorship from Genzyme and Roche
Dr Milena Sales Pitombeira: nothing to disclose
Dr Frederico Mennucci Haidar Jorge: nothing to disclose
Dr Douglas K. Sato: research support from Japan Society for promotion of Science (JSPS KAKENHI 1K19472), CAPES/brasil (88887.091277/2014-00), Euroimmun AG and TEVA. Speaker for Biogen, Novartis, Genzyme, TEVA, Merck-Serono, Roche, BAyer and advisory board for Shire, Merck-Serono and Quest/Athena Diagnostics
Dr Dagoberto Callegaro received grants related to congress meetings and preceptorship from Genzyme, Roche and Biogen
Abstract: P1153
Type: Poster
Abstract Category: Therapy - disease modifying - 26 Immunomodulation/Immunosuppression
Introduction: Neuromyelitis optica spectrum disorders (NMOSD) are recurrent and disabling diseases with clinical attacks mainly involving optic nerves and the spinal cord. Azathioprine and mycophenolate mofetil are commonly recommended as first-line treatments, however a substantial percentage of patients do not show response to therapy. Rituximab is a monoclonal antibody directed against CD20 B-lymphocyte surface antigen, and is usually accepted that provides better disease stabilization than other therapies available to date. Although most studies adopt a treatment-to-target approach using peripheral blood B-cell monitoring, there is no defined protocol regarding retreatment strategies. Considering that flow cytometric analyses are not usually available in public health services in developing countries, we report our experience with antiAQP4 positive patients who received rituximab treatment without regular peripheral B-cell monitoring.
Methods: We performed a retrospective review of patients with NMOSD and positive AQP4 antibodies who received rituximab for at least six months. Rituximab was administered with an induction treatment of 1000mg infused twice during a 2-week interval. Most patients received a maintenance treatment of 500mg infused twice during a two-week interval every six months regardless of peripheral B-cell monitoring. Delayed retreatment was a frequent concern due to medication availability.
Results: 13 patients were included (mean age 41, F/M sex ratio 12/1). Mean prerituximab annualized relapse rate (ARR) was 1.79, and mean postrituximab ARR was 0.33 (P=0.0005). Of 13 patients, 8 (62%) showed marked reduction in the ARR (< 25% prerituxumab AAR). Median EDSS score was 7 (range 5-8) before rituximab treatment, and 8 (range 5-8) after rituximab treatment (P=0.75). A marked proportion (78%) of relapses occurred in periods of delayed retreatment.
Conclusion: Our 6-month reinfusion protocol is effective in reducing relapse risk, and may be considered as an option when B-cell monitoring is not available. Delayed retreatment should be avoided without regular peripheral B-cell monitoring.
Disclosure: Dr Pedro Henrique Bruel Torretta: nothing to disclose
Dr Samira Luíza Apóstolos Pereira received grants related to congress meetings and preceptorship from Genzyme and Roche
Dr Milena Sales Pitombeira: nothing to disclose
Dr Frederico Mennucci Haidar Jorge: nothing to disclose
Dr Douglas K. Sato: research support from Japan Society for promotion of Science (JSPS KAKENHI 1K19472), CAPES/brasil (88887.091277/2014-00), Euroimmun AG and TEVA. Speaker for Biogen, Novartis, Genzyme, TEVA, Merck-Serono, Roche, BAyer and advisory board for Shire, Merck-Serono and Quest/Athena Diagnostics
Dr Dagoberto Callegaro received grants related to congress meetings and preceptorship from Genzyme, Roche and Biogen