• Su Yeon Park, Young Nam Kwon, Sunyoung Kim, Seung-Hyun Kim, Jong Kuk Kim, Jun-Soon Kim, Tai-Seung Nam, Young Gi Min, Kyung Seok Park, Jin-Sung Park, Jin Myoung Seok, Jung-Joon Sung, Eunhee Sohn, Kyong Jin Shin, Jin-Hong Shin, Ha Young Shin, Seong-Il Oh, Jeeyoung Oh, Byeol-A Yoon, Sanggon Lee, Jong-Mok Lee, Hye Lim Lee, Kyomin Choi, So-Young Huh, Myoung-Jin Jang, Ju-Hong Min, Byoung Joon Kim, and Sung-Min Kim.
• Department of Neurology, Korea Cancer Center Hospital, Seoul, Korea (the Republic of).
• J. Neurol. Neurosurg. Psychiatr. 2023 Oct 1; 94 (10): 800805800-805.

BackgroundNeuromyelitis optica spectrum disorder (NMOSD) causes relapsing inflammatory attacks in the central nervous system, leading to disability. As rituximab, a B-lymphocyte-depleting monoclonal antibody, is an effective in preventing NMOSD relapses, we hypothesised that earlier initiation of rituximab can also reduce long-term disability of patients with NMOSD.MethodsThis multicentre retrospective study involving 19 South Korean referral centres included patients with NMOSD with aquaporin-4 antibodies receiving rituximab treatment. Factors associated with the long-term Expanded Disability Status Scale (EDSS) were assessed using multivariable regression analysis.ResultsIn total, 145 patients with rituximab treatment (mean age of onset, 39.5 years; 88.3% female; 98.6% on immunosuppressants/oral steroids before rituximab treatment; mean disease duration of 121 months) were included. Multivariable analysis revealed that the EDSS at the last follow-up was associated with time to rituximab initiation (interval from first symptom onset to initiation of rituximab treatment). EDSS at the last follow-up was also associated with maximum EDSS before rituximab treatment. In subgroup analysis, the time to initiation of rituximab was associated with EDSS at last follow-up in patients aged less than 50 years, female and those with a maximum EDSS score ≥6 before rituximab treatment.ConclusionsEarlier initiation of rituximab treatment may prevent long-term disability worsening in patients with NMOSD, especially among those with early to middle-age onset, female sex and severe attacks.© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.

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