Efficacy and Safety of Rituximab in Central Nervous System Demyelinating Disorders

Area of Science:

• Neuroimmunology
• Clinical Neurology
• Pharmacology

Background:

• Rituximab, an anti-CD20 monoclonal antibody, is utilized off-label for multiple sclerosis (MS) and neuromyelitis optica spectrum disorders (NMOSD).
• Evaluating rituximab's efficacy and safety in central nervous system demyelinating disorders is crucial, particularly in diverse populations.

Purpose of the Study:

• To assess the efficacy and safety of rituximab in Indian patients diagnosed with MS, NMOSD, and MOGAD.
• To provide context-specific data on rituximab treatment for these neurological conditions.

Main Methods:

• Retrospective analysis of 102 patients (MS, NMOSD, MOGAD) treated with rituximab.
• Data collection included relapse rates, disability status (EDSS), MRI findings, and adverse events.
• Treatment occurred at a single tertiary care center in Mumbai between June 2008 and January 2020.

Main Results:

• High relapse-free rates observed: 96.7% for MS, 67% for NMOSD, and 50% for MOGAD.
• Significant reduction in annualized relapse rates across all studied conditions.
• MRI showed decreased new inflammatory lesions in MS patients; adverse events (infusion reactions, infections) occurred in 12 patients.

Conclusions:

• Rituximab is an effective treatment for MS and NMOSD in the Indian population.
• The safety profile of rituximab in this cohort was acceptable, with manageable adverse events.
• Further research may explore rituximab's role in MOGAD and long-term outcomes.