Yang Y, et al. - Among patients with neuromyelitis optica spectrum disorder, researchers evaluated and compared the efficacy and tolerability of azathioprine (AZA), mycophenolate mofetil (MMF) and lower dosages of rituximab (RTX). as per findings, AZA, MMF and reduced dosages of rituximab were all efficacious in reducing ARR and improving the clinical symptom of these patients. Compared to others, lower dosages of RTX proved more effective in decreasing the CD19 B-cell counts. Relative to AZA, MMF and reduced RTX decreased AQP-4-IgG titre more and caused fewer adverse events.

Methods

• Researchers enrolled AQP4-IgG-seropositive patients with neuromyelitis optica spectrum disorder (NMOSD) in this prospective cohort.
• Division of the patients into three groups was performed, using AZA, MMF or lower dosages of RTX (defined as 100 mg RTX intravenous injection, once per week for 4 consecutive weeks) respectively.
• The groups were compared for annualized relapse rate (ARR), EDSS scores, CD19+ B-cell counts in peripheral blood, serum AQP-4-IgG titre and drug adverse reactions.

Results

• In the AZA group (n = 22), MMF group (n = 30) and RTX group (n = 20), a relapse-free state was achieved by 54.5%, 60.0% and 65.0% of patients and improvement in EDSS score was evident in 90.9%, 83.3% and 90.0% of patients, respectively.
• Moreover, a significant reduction in ARR was observed in all the three groups.
• Reduced dosage of RTX led to a significant reduction in CD19+ B-cell counts (P < 0.01).
• The MMF group and the RTX group decreased the AQP-4-IgG titre evidently and showed fewer adverse events compared with the AZA group.
• Among the three groups, neither the Kaplan-Meier survival curves nor the Cox proportional hazard model showed a significant difference in relapse (P > 0.05).