Evaluating Rituximab Failure Rates in Neuromyelitis Optica Spectrum Disorder: A Nationwide Real-World Study From South Korea
- Author:
Su-Hyun KIM
1
;
Ju-Hong MIN
;
Sung-Min KIM
;
Eun-Jae LEE
;
Young-Min LIM
;
Ha Young SHIN
;
Young Nam KWON
;
Eunhee SOHN
;
Sooyoung KIM
;
Min Su PARK
;
Tai-Seung NAM
;
Byeol-A YOON
;
Jong Kuk KIM
;
Kyong Jin SHIN
;
Yoo Hwan KIM
;
Jin Myoung SEOK
;
Jeong Bin BONG
;
Sohyeon KIM
;
Hung Youl SEOK
;
Sun-Young OH
;
Ohyun KWON
;
Sunyoung KIM
;
Sukyoon LEE
;
Nam-Hee KIM
;
Eun Bin CHO
;
Sa-Yoon KANG
;
Seong-il OH
;
Jong Seok BAE
;
Suk-Won AHN
;
Ki Hoon KIM
;
You-Ri KANG
;
Woohee JU
;
Seung Ho CHOO
;
Yeon Hak CHUNG
;
Jae-Won HYUN
;
Ho Jin KIM
Author Information
- Publication Type:ORIGINAL ARTICLE
- From:Journal of Clinical Neurology 2025;21(2):131-136
- CountryRepublic of Korea
- Language:English
-
Abstract:
Background:and Purpose Treatments for neuromyelitis optica spectrum disorder (NMOSD) such as eculizumab, ravulizumab, satralizumab, and inebilizumab have significantly advanced relapse prevention, but they remain expensive. Rituximab is an off-label yet popular alternative that offers a cost-effective solution, but its real-world efficacy needs better quantification for guiding the application of newer approved NMOSD treatments (ANTs). This study aimed to determine real-world rituximab failure rates to anticipate the demand for ANTs and aid in resource allocation.
Methods:We conducted a nationwide retrospective study involving 605 aquaporin-4-antibody-positive NMOSD patients from 22 centers in South Korea that assessed the efficacy and safety of rituximab over a median follow-up of 47 months.
Results:The 605 patients treated with rituximab included 525 (87%) who received continuous therapy throughout the follow-up period (median=47 months, interquartile range=15–87 months). During this period, 117 patients (19%) experienced at least 1 relapse. Notably, 68 of these patients (11% of the total cohort) experienced multiple relapses or at least 1 severe relapse.Additionally, 2% of the patients discontinued rituximab due to adverse events, which included severe infusion reactions, neutropenia, and infections.
Conclusions:This study has confirmed the efficacy of rituximab in treating NMOSD, as evidenced by an 87% continuation rate among patients over a 4-year follow-up period. Nevertheless, the occurrence of at least one relapse in 19% of the cohort, including 11% who experienced multiple or severe relapses, and a 2% discontinuation rate due to adverse events highlight the urgent need for alternative therapeutic options.
