ArticleEuropean journal of neurology2025
Rituximab as First-Line Compared to Escalation Immunotherapy Is Associated With Lower Disability Accumulation in Aquaporin-4-IgG-Positive Neuromyelitis Optica Spectrum Disorder: A Multicenter Cohort Study From Germany and the United Kingdom.
Article in European journal of neurology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers, 1 of them a synthesis that pooled it.
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Who cites it
3 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Monoclonal antibodies in neuromyelitis optica spectrum disorder: a systematic review and meta-analysis.BMC neurology · 2026Pooled it
- Article
- Optimizing Rituximab Maintenance Therapy: Outcomes of Extended-Interval Dosing in Multiple Sclerosis and Neuromyelitis Optica Spectrum Disorder.Journal of clinical medicine research · 2026Article
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13 authors.
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Abstract
backgroundAquaporin-4-IgG-positive neuromyelitis optica spectrum disorder (AQP4-IgG+ NMOSD) can cause significant disability after a single attack. Long-term immunotherapy reduces disability accumulation, but the choice of first-line therapy varies. In the United Kingdom, rituximab is typically used as escalation therapy after conventional immunosuppressants fail, while in Germany, it is widely used as first-line treatment.
methodsWe compared attack risk and disability outcomes based on the Expanded Disability Status Scale (EDSS) in AQP4-IgG+ NMOSD patients treated with rituximab as first-line versus escalation therapy. Furthermore, attack suppression and risk factors for attacks in individuals who received treatment with azathioprine and mycophenolate mofetil (with/without escalating to rituximab) were analyzed.
resultsThe risk of attack was lower in individuals who received rituximab as first-line therapy (n = 52) compared to escalation therapy (n = 81, HR = 0.45, 95% CI = 0.30-0.67). Once escalated to rituximab, there was no altered risk of attack between first-line rituximab and escalation therapy (HR = 1.15, 95% CI = 0.64-2.08). Rituximab as first-line compared to escalation therapy was associated with lower EDSS scores at therapy start (3.0 vs. 6.0, p = 1.10 × 10
conclusionsRituximab as a first-line therapy shows significant reduction in disability accumulation compared to escalation treatments. However, a subgroup of patients with AQP4-IgG+ NMOSD may still respond well to conventional immunosuppression-specifically older patients treated with mycophenolate mofetil.
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