Ofatumumab for the Treatment of Anti-Neurofascin 155 Autoimmune Nodopathy: A Case Series

Autoimmune nodopathy (AN) is a rare immune-mediated peripheral neuropathy, the diagnosis and treatment of which remain challenging. Anti-neurofascin-155 (NF155) AN present with weakness, tremor, ataxia, and cranial nerve involvement. Ofatumumab, a second-generation anti-CD20 monoclonal antibody, functions by depleting B lymphocytes. This study aimed to investigate the efficacy of ofatumumab treatment in NF155 AN.

We reviewed data on ofatumumab treatment of patients with anti-NF155 AN at the Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology from January 2020 to September 2024.

A total of four patients with anti-NF155 AN were included, consisting of three males and one female. The onset age ranged from 9 to 27 years. All cases exhibited distal sensory-motor neuropathy accompanied by tremors and ataxia. All the patients received corticosteroids or other immunotherapy or both before treatment with ofatumumab. The duration of treatment with ofatumumab ranged from 6 to 25 months, with a follow-up period of 6-28 months. The clinical improvements of patients were assessed using the Inflammatory Neuropathy Cause and Treatment Disability Score, the Medical Research Council Muscle Strength Score, and the Modified Rankin Scale. All four patients demonstrated significant clinical improvement following ofatumumab treatment, which was concurrently accompanied by varying levels of improvement in imaging and nerve conduction studies. Throughout the treatment period, the patients did not report any adverse reactions to ofatumumab.

Our research findings suggested that ofatumumab holds significant potential for treating anti-NF155 AN.