Prolonged effect of temporary rituximab therapy in neuromyelitis optica - A case study

Aim: Neuromyelitis optica is an autoimmune disorder connected with the effect of IgG antibodies against water channels (aquaporin-4) in the central nervous system. In the course of the disease, there is the involvement of the optic nerves and the spinal cord, resulting in a progressive disability. In the treatment, immunosuppressive agents are used as well as monoclonal antibodies such as rituximab (anti-CD20). According to the results, rituximab is the most effective, safe and recommended as a first-line treatment. Until now the duration and frequency of this therapy has not been established. The aim of this report is to provide the information necessary to create the optimal rituximab dosing regimen. Case: An NMO patient, who was treated with rituximab for 6 years depending on the blood CD19+ B lymphocytes titres, is presented here. The complete relapse restrain and clinical stabilisation were achieved, with beneficial effect remaining even after the rituximab treatment was terminated -present observation period is almost 4 years without any immunosuppressive or immunomodulating treatment. Since the treatment was stopped, the CD19+ B lymphocyte population tends to rise, but the neurological state has not changed. The most recent magnetic resonance imaging (MRI) of the cervical spine, from 2014, showed a post-inflammatory lesion between the medulla and the cervical spine, which had been present before, without any new inflammatory lesions. The IgG antibodies against AQP-4 assays were performed in 2013 for the first time and were negative. Comment: Temporary rituximab therapy in neuromyelitis optica may lead to a prolonged remission lasting some years. (C) 2015 Institute of Psychiatry and Neurology. Published by Elsevier Sp.zo. o.All rights reserved.