Analysis of the treatment of neuromyelitis optica

• Rituximab significantly reduces annualized relapse rates in patients with NMO.
• Rituximab significantly improves disability in patients with NMO.
• When compared to azathioprine rituximab significantly reduced relapse rates.
• Rituximab has comparable tolerability to other immunosuppressive treatments for NMO.

BackgroundTreatment options for neuromyelitis optica (NMO) are currently based on small retrospective case series and open label studies, ranging from 10 to 103 patients.ObjectiveTo compare the efficacy and tolerability of azathioprine, cyclophosphamide, mycophenolate, and rituximab in patients with neuromyelitis optica.MethodsThis is a retrospective chart review and telephone follow-up study of 71 patients with NMO or NMO spectrum disorder, 54 of whom were treated with the study drugs. We compared adverse events, annualized relapse rates and expanded disability status scales before and after treatment.ResultsThe median ARR decreased from 1.17 to 0.25 on rituximab (P < 0.01), 0.92 to 0.56 on azathioprine (P = 0.475), 1.06 to 0.39 on mycophenolate (P < 0.05) and 1.30 to 0.92 on cyclophosphamide (P = 0.746). When compared directly to azathioprine, rituximab significantly reduced relapse rates (P = 0.021). The median EDSS decreased from 7 to 5 on rituximab (P < 0.01) and 7 to 6 on azathioprine (P < 0.01), and did not change significantly on mycophenolate (4 to 5; P = 0.463) or cyclophosphamide (6.5 to 6.5; P = 0.881). Twenty-five percent of patients noted adverse events on rituximab, 36% on azathioprine, 36% on mycophenolate, and 80% on cyclophosphamide.ConclusionRituximab significantly reduces relapse rates and improves disability while maintaining comparable tolerability to other immunosuppressive treatments for NMO.