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Ong et al. Neuroimmunol Neuroinflammation 2020;7:311-8 Neuroimmunology
DOI: 10.20517/2347-8659.2020.05 and Neuroinflammation

Original Article Open Access

Clinical efficacy and safety of single cycle rituximab
as induction therapy for aggressive neuromyelitis
optica spectrum disorder in a resource limited

center: a preliminary study

Tien Lee Ong , Shanthi Viswanathan , Sheila Ong , Fu Liong Hiew 1
1
1,2
1
1 Department of Neurology, Hospital Kuala Lumpur, Kuala Lumpur 50586, Malaysia.
2 Neurology Unit, Medical Department, Hospital Sungai Buloh, Sungai Buloh 47000, Malaysia
Correspondence to: Dr. Tien Lee Ong, Neurology Unit, Medical Department, Hospital Sungai Buloh, Jalan Hospital, Sungai
Buloh 47000, Malaysia. E-mail: ongtienlee@gmail.com

How to cite this article: Ong TL, Viswanathan S, Ong S, Hiew FL. Clinical efficacy and safety of single cycle rituximab as induction
therapy for aggressive neuromyelitis optica spectrum disorder in a resource limited center: a preliminary study. Neuroimmunol
Neuroinflammation 2020;7:311-8. http://dx.doi.org/10.20517/2347-8659.2020.05

Received: 9 Jan 2020 First Decision: 4 Mar 2020 Revised: 14 Mar 2020 Accepted: 27 Apr 2020 Available online: 12 Jul 2020
Academic Editor: Athanassios P. Kyritsis Copy Editor: Jing-Wen Zhang Production Editor: Tian Zhang

Abstract
Aim: To analyse the efficacy of single dose rituximab (RTX) as induction therapy followed by conventional oral
steroid-sparing agents (azathioprine, mycophenolate mofetil or methotrexate) in a cohort of patients with
aggressive neuromyelitis optica spectrum disorder (NMOSD) without CD19, 20 and 27 biomarker testing.

Methods: A retrospective analysis of clinical outcomes in eight patients with aggressive NMOSD treated with
one course of RTX induction therapy in the Neurology Department at Kuala Lumpur Hospital from 2005 to
2018 was performed. The effectiveness of the treatment was determined by the number of relapses, expanded
disability status scale, annualized relapsed rates, and modified Rankin Scale both before and after treatment. B cell
enumeration testing was done instead of CD19, 20 and 27 biomarker testing.

Results: There was a reduction in the mean annualized relapse rate from 4.7 to 0.5 attacks per year after treatment
(P = 0.011). Mean expanded disability status scale and modified Rankin Scale values improved from 5.4 to 3.6
(P = 0.018) and 3.6 to 2.6 (P = 0.023), respectively. No patient developed any adverse effect.

Conclusion: Single-course RTX induction therapy regime may be an alternative therapeutic option in resource
limited hospitals to suppress NMOSD disease activity in the short term as pulse induction therapy whilst awaiting
the effectiveness of conventional steroid-sparing agents. Further prospectively designed studies are required to
prove efficacy.

© The Author(s) 2020. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long
as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license,
and indicate if changes were made.

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