Rituximab shows promising effects in patients with NMOSD, but is less effective in patients with MOGAD.
The efficacy of rituximab in patients with myelin oligodendrocyte glycoprotein antibody-associated disorders (MOGADs) is not fully understood but has been shown to be relatively greater for aquaporin-4-IgG-positive neuromyelitis optica spectrum disorders (AQP4-IgG+NMOSDs). This study, published in the Journal of Neurology, Neurosurgery, and Psychiatry, provides a systematic review and meta-analysis with the aim of evaluating the efficacy and safety profile of rituximab treatment for MOGAD patients, and comparing these results to those for similar patients with AQP4-IgG+NMOSD.
The literature review used for this study relied on articles published between 2012 and 2021, reporting on rituximab efficacy in patients with MOGAD. The main outcome measurements used were annualized relapse rate (ARR) and Expanded Disability Status Scale (EDSS) score mean differences after rituximab treatment. The meta-analysis used a random effects model, and covariates associated with the outcome measures were analyzed using a linear meta-regression.
The data included 315 patients (mean onset age 26.8 years) from 32 studies. After rituximab treatment, a significant decrease in ARR was found, although it was markedly lower than the decrease in NMOSD patients (-1.73 for AQP4-IgG+NMOSD vs -0.92 for MOGAD). When controlling for the mean ARR pre-treatment, this difference was not as significant. EDSS scores decreased significantly after treatment, and the rate of adverse events was 18.8%. The authors note that rituximab treatment does seem effective in MOGAD, although it is not nearly as effective as it is for patients with AQP4-IgG+NMOSD. Furthermore, the safety profile warrants caution in prescribing this medication due to the frequency of adverse events in MOGAD patients.
Spagni, G., Sun, B., Monte, G., Sechi, E., Iorio, R., Evoli, A., & Damato, V. (2023). Efficacy and safety of rituximab in myelin oligodendrocyte glycoprotein antibody-associated disorders compared with neuromyelitis optica spectrum disorder: a systematic review and meta-analysis. Journal of Neurology, Neurosurgery and Psychiatry, 94(1), 62-69. https://doi.org/10.1136/jnnp-2022-330086