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Background: Neuromyelitis optica (NMO) is a severe autoimmune disorder of inflammatory central nervous system, which often resulting in paralysis or blindness. Rituximab (RTX) is a mouse-human chimeric monoclonal antibody specific for the CD20 antigen on B lymphocytes used to treat many autoimmune diseases. To evaluate the effectiveness of RTX, Disability and relapses were measured by the Expanded Disability Status Scale (EDSS) and annualized relapse rate (ARR) ratio. This review performed a meta-analysis of the efficacy of rituximab use in NMO.
Methods: We searched through the databases of PubMed, Embase, and Cochrane Library. We compiled 27 studies in this meta-analysis: 19 used ARR ratio, 23 used EDSS score, and there are 15 studies in the two main variables. Differences in the ARR ratio and EDSS score before and after rituximab therapy were the main efficacy measures. After a consistency test, the publication bias was evaluated and a sensitivity analysis was performed with mean difference (MD) of the efficacy of rituximab.
Results: A meta-analysis of 27 studies with 607 participants total was conducted. NMO patients have antibodies against aquaporin 4 autoantibody (AQP4-Ab) were recorded in 456 of 607 (75.12%). Rituximab therapy resulted in a mean (WMD) −1.58 (95%CI, −1.85 to −1.32) reduction in the mean ARR ratio and a mean (WMD) −1.17 (95%CI, −1.37 to −0.97) reduction in the mean EDSS score. 351 of 558 patients (62.9%) reached a relapse-free state. 107 of 607 (17.63%) patients had adverse reactions.
Conclusions: RTX has acceptable tolerance, reduces the frequency of relapse, and improves disability in most patients. However, treatment with RTX in reducing health-care costs， improving functional outcome and reducing adverse effects should be carefully addressed in future studies.
Keywords
Neuromyelitis optica, Rituximab, meta-analysis, aquaporin-4 autoantibody, annualized relapse rate, Expanded Disability Status Scale
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CURRENT STATUS: Published
View the published article at BMC Neurology.
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Editor assigned
On 18 Feb, 2019
Editorial decision: Accept
On 18 Feb, 2019
Submission checks complete
On 06 Nov, 2018
Version 2
Posted 20 Jan, 2019
No comments provided
Review #1 received
Received 18 Jan, 2019
Editorial decision: Revise
On 18 Jan, 2019
Review #2 received
Received 18 Jan, 2019
Editor assigned
On 14 Jan, 2019
Reviewers invited
Invitations sent on 14 Jan, 2019
Reviewer #1 agreed
On 14 Jan, 2019
Review #1 received
Received 14 Jan, 2019
No comments provided
Review #2 received
Received 16 Dec, 2018
Editorial decision: Revise
On 16 Dec, 2018
Reviewer #3 agreed
On 10 Dec, 2018
Review #1 received
Received 29 Nov, 2018
Reviewer #2 agreed
On 16 Nov, 2018
Reviewers invited
Invitations sent on 11 Nov, 2018
Reviewer #1 agreed
On 11 Nov, 2018
Editor assigned
On 09 Nov, 2018
Editor invited
On 06 Nov, 2018
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Subject Areas
Internal Medicine Specialties
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A new preprint design is coming!
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See the published version of this preprint at BMC Neurology.
This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research Article
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
View the published article at BMC Neurology.
No community comments so far
Editor assigned
On 18 Feb, 2019
Editorial decision: Accept
On 18 Feb, 2019
Submission checks complete
On 06 Nov, 2018
Version 2
Posted 20 Jan, 2019
No comments provided
Review #1 received
Received 18 Jan, 2019
Editorial decision: Revise
On 18 Jan, 2019
Review #2 received
Received 18 Jan, 2019
Editor assigned
On 14 Jan, 2019
Reviewers invited
Invitations sent on 14 Jan, 2019
Reviewer #1 agreed
On 14 Jan, 2019
Review #1 received
Received 14 Jan, 2019
No comments provided
Review #2 received
Received 16 Dec, 2018
Editorial decision: Revise
On 16 Dec, 2018
Reviewer #3 agreed
On 10 Dec, 2018
Review #1 received
Received 29 Nov, 2018
Reviewer #2 agreed
On 16 Nov, 2018
Reviewers invited
Invitations sent on 11 Nov, 2018
Reviewer #1 agreed
On 11 Nov, 2018
Editor assigned
On 09 Nov, 2018
Editor invited
On 06 Nov, 2018
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Internal Medicine Specialties
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at BMC Neurology.
Background: Neuromyelitis optica (NMO) is a severe autoimmune disorder of inflammatory central nervous system, which often resulting in paralysis or blindness. Rituximab (RTX) is a mouse-human chimeric monoclonal antibody specific for the CD20 antigen on B lymphocytes used to treat many autoimmune diseases. To evaluate the effectiveness of RTX, Disability and relapses were measured by the Expanded Disability Status Scale (EDSS) and annualized relapse rate (ARR) ratio. This review performed a meta-analysis of the efficacy of rituximab use in NMO.
Methods: We searched through the databases of PubMed, Embase, and Cochrane Library. We compiled 27 studies in this meta-analysis: 19 used ARR ratio, 23 used EDSS score, and there are 15 studies in the two main variables. Differences in the ARR ratio and EDSS score before and after rituximab therapy were the main efficacy measures. After a consistency test, the publication bias was evaluated and a sensitivity analysis was performed with mean difference (MD) of the efficacy of rituximab.
Results: A meta-analysis of 27 studies with 607 participants total was conducted. NMO patients have antibodies against aquaporin 4 autoantibody (AQP4-Ab) were recorded in 456 of 607 (75.12%). Rituximab therapy resulted in a mean (WMD) −1.58 (95%CI, −1.85 to −1.32) reduction in the mean ARR ratio and a mean (WMD) −1.17 (95%CI, −1.37 to −0.97) reduction in the mean EDSS score. 351 of 558 patients (62.9%) reached a relapse-free state. 107 of 607 (17.63%) patients had adverse reactions.
Conclusions: RTX has acceptable tolerance, reduces the frequency of relapse, and improves disability in most patients. However, treatment with RTX in reducing health-care costs， improving functional outcome and reducing adverse effects should be carefully addressed in future studies.
Figure 1
Figure 2
Figure 3
Figure 4
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