Preprint Article Version 1 Preserved in Portico This version is not peer-reviewed

Effectiveness and Safety of Low-dose Rituximab in the treatment of Demyelinating Diseases of the Central Nervous System

Version 1 : Received: 26 December 2020 / Approved: 28 December 2020 / Online: 28 December 2020 (13:22:04 CET)

How to cite: Mokhtari, M.; Abolmaali, M.; Emamikhah, M.; Mohebi, N.; Hatam, J.; Amini, E.; Saiyarsarai, P.; Habibi, S.A.H.; Moghaddasi, M. Effectiveness and Safety of Low-dose Rituximab in the treatment of Demyelinating Diseases of the Central Nervous System. Preprints 2020, 2020120705 (doi: 10.20944/preprints202012.0705.v1). Mokhtari, M.; Abolmaali, M.; Emamikhah, M.; Mohebi, N.; Hatam, J.; Amini, E.; Saiyarsarai, P.; Habibi, S.A.H.; Moghaddasi, M. Effectiveness and Safety of Low-dose Rituximab in the treatment of Demyelinating Diseases of the Central Nervous System. Preprints 2020, 2020120705 (doi: 10.20944/preprints202012.0705.v1).

Abstract

Background: Rituximab is a monoclonal antibody widely used in the treatment of inflammatory and autoimmune disorders. Despite reports of its effectiveness in the treatment of demyelinating diseases of central nervous system (DDCNS), it is not yet approved for use in these disorders. The aim of this study was to investigate the effectiveness and safety of low dose rituximab in three different subgroups of DDCNS including relapsing-remitting multiple sclerosis (RRMS), secondary-progressive multiple sclerosis (SPMS) and neuromyelitis-optica-spectrum disorders (NMOSD).Methods: In a prospective cohort study, we monitored expanded-disability-status-scale (EDSS), relapses (new attacks) and serum-IgG levels to assess effectiveness and drug-adverse-events for safety in patients with RRMS, SPMS and NMOSD. These patients were candidates to receive rituximab according to our common practice protocol. We switched patients to rituximab if there was poor response to first line therapies. We follow a low dose protocol in our center (500 mg twice, two weeks apart, repeating every six months) and these patients treated in a 4-year period were assessed retrospectively for evaluation of our protocol’s safety and effectiveness. Results: 99 patients (42 RRMS, 43 SPMS and 14 NMOSD) received rituximab for a range of 12 to 40 months period. New attacks occurred in 8 RRMS (19%), 10 SPMS (23%) and 1 NMOSD (7%) patients. EDSS decreased in RRMS and NMOSD cases. Serum-IgG levels decremented in SPMS and NMOSD patients. Drug-adverse-events happened in two cases.Conclusion: In this study, low dose rituximab showed substantial effectiveness in preventing disease progression with a considerably good safety profile.

Subject Areas

Rituximab; Multiple Sclerosis; Neuromyelitis Optica; demyelinating diseases

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