Monitoring CD27+ memory B-cells in neuromyelitis optica spectrum disorders patients treated with rituximab: Results from a bicentric study

J Neurol Sci. 2017 Feb 15:373:335-338. doi: 10.1016/j.jns.2017.01.025. Epub 2017 Jan 10.

Abstract

Background: Rituximab (RTX) is increasingly used in the treatment of neuromyelitis optica spectrum disorder (NMO-SD). Administration regimen is not consensual as there is no reliable biomarker of RTX efficacy. In most cases, after induction, RTX is administered systematically every 6months.

Objective: To assess efficacy and safety of a maintenance regimen based on CD19+ CD27+ memory B-cell (mBc) detection.

Methods: We conducted a study in two French centers, including patients with NMO-SD who received an induction therapy with RTX. We compared the number of administered infusions, relapses and EDSS depending on two maintenance schemes (S1: administration of 1g RTX infusion every 6months or S2: a scheme based on regular mBc detection. 1g RTX was administered if mBc was >0.05%) RESULTS: 40 patients were included (mean age: 40.2years, F/M sex ratio: 5/1). Aquaporin-4 antibodies were positive in 75% patients. Under S1 regimen, all patients received 2 infusions per year, whereas under S2, they received 1.62 infusion per year. The mean interval between infusions under S2 was 7.4months, without decrease of clinical efficacy.

Conclusion: In our study, mBc-based administration of RTX allowed personalizing treatment administration and in several cases to lower the cumulative dose without loss of efficacy.

Keywords: Biomarkers; Health care costs; Immunology; Monoclonal antibodies; NMO; Rituximab.

Publication types

  • Multicenter Study

MeSH terms

  • Adult
  • Antigens, CD19 / analysis
  • Aquaporin 4 / immunology
  • Autoantibodies / blood
  • B-Lymphocyte Subsets / drug effects*
  • B-Lymphocyte Subsets / immunology
  • Biomarkers / blood
  • Dose-Response Relationship, Drug
  • Drug Administration Schedule
  • Feasibility Studies
  • Female
  • Humans
  • Immunologic Factors / administration & dosage*
  • Immunologic Factors / adverse effects
  • Immunologic Memory
  • Lymphocyte Count
  • Male
  • Middle Aged
  • Neuromyelitis Optica / drug therapy*
  • Neuromyelitis Optica / immunology*
  • Precision Medicine / methods*
  • Prospective Studies
  • Recurrence
  • Rituximab / administration & dosage*
  • Rituximab / adverse effects
  • Treatment Outcome
  • Tumor Necrosis Factor Receptor Superfamily, Member 7 / analysis
  • Young Adult

Substances

  • AQP4 protein, human
  • Antigens, CD19
  • Aquaporin 4
  • Autoantibodies
  • Biomarkers
  • CD19 molecule, human
  • Immunologic Factors
  • Tumor Necrosis Factor Receptor Superfamily, Member 7
  • Rituximab