Recommendations for the use of Rituximab in neuromyelitis optica spectrum disorders - 19/04/18

Doi : 10.1016/j.neurol.2017.11.005

J. Ciron ^a,^b,^⁎ , B. Audoin ^c,^d, B. Bourre ^e, D. Brassat ^a,^f, F. Durand-Dubief ^g, D. Laplaud ^h, E. Maillart ⁱ, C. Papeix ⁱ, S. Vukusic ^g,^j,^k, H. Zephir ^l, R. Marignier ^g,^m,^{^{1
Dr Collongues and Dr Marignier contributed equally to the work.}}, N. Collongues ^n,^o,^p,^{^{1
Dr Collongues and Dr Marignier contributed equally to the work.}}
on behalf of the
NOMADMUS group, under the aegis of OFSEP, SFSEP
^a Pôle de neurosciences, department of neurology, hôpital Pierre-Paul-Riquet, university hospital of Toulouse, place du Dr-Baylac, 31059 Toulouse Cedex 9, France
^b Pôle neurosciences locomoteur, department of neurology, university hospital of Poitiers, 2, rue de la Milétrie, 86021 Poitiers Cedex, France
^c Pôle de neurosciences cliniques, department of beurology, hôpital de la Timone, AP–HM, 13005 Marseille, France
^d CNRS, CRMBM UMR 7339, Aix-Marseille University, 13005 Marseille, France
^e Department of neurology, university hospital of Rouen, 76000 Rouen, France
^f UMR 1043, University Toulouse III, 31400 Toulouse, France
^g Department of neurology, Sclérose en Plaques, pathologies de la myéline et neuro-inflammation, hôpital neurologique Pierre-Wertheimer, hospices civils de Lyon, 69677 Lyon, France
^h Department of neurology, university hospital of Nantes, 44093 Nantes, France
ⁱ Department of neurology, Pitié-Salpêtrière Hospital, AP–HP, 75013 Paris, France
^j Inserm U1028 CNRS UMR 5292, Observatoire français de la Sclérose en Plaques, centre des neurosciences de Lyon, 69003 Lyon, France
^k University Lyon 1, 69003 Lyon, France
^l Department of neurology, university hospital of Lille, 59037 Lille, France
^m Inserm U1028 CNRS UMR 5292, FLUID Team, faculté de médecine Laennec, centre de recherche en neurosciences de Lyon, 69008 Lyon, France
ⁿ Department of neurology, university hospital of Strasbourg, 67200 Strasbourg, France
^o Clinical Investigation Center, Inserm U1434, university hospital of Strasbourg, 67200 Strasbourg, France
^p Biopathology of Myelin, neuroprotection and therapeutic Strategies, Inserm U1119, university hospital of Strasbourg, 67200 Strasbourg, France

^⁎Corresponding author.Pôle de neurosciences, department of neurology, hôpital Pierre-Paul-Riquet, university hospital of Toulouse, place du Dr-Baylac, 31059 Toulouse cedex 9, France

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Abstract

There is growing evidence of a preventive effect of Rituximab (RTX) in neuromyelitis optica spectrum disorders (NMO-SD). This monoclonal antibody against CD20 is becoming the most widely used preventive therapy in NMO-SD, as a first-line therapy or as a rescue therapy. Nevertheless, considerable heterogeneity still exists concerning the pre-treatment work-up, the vaccinations required before and under treatment, the number and dosage of infusions, prevention of the risk of infusion-related reactions, prevention of infections under treatment, and frequency of therapeutic cycles. Thanks to a collaborative work among NMO-SD experts belonging to the NOMADMUS project, we provide here recommendations for all these topics concerning RTX use in NMO-SD.

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Keywords : Neuromyelitis optica, Rituximab, Guidelines, Recommendations, Treatment

Plan

Introduction

Question 1: work up before starting rituximab

Question 2: vaccinations before starting rituximab and under treatment

Question 3: timing of rituximab start

Question 4: modality of induction treatment by rituximab

Question 5: infectious risk under rituximab and preventive measures

Question 6: monitoring of RTX re-infusion: tools, rate and posology

Question 7: therapeutic combination

Question 8: pregnancy, breastfeeding

Before pregnancy and pregnancy exposed to rituximab

Disclosure of interest

Informations about OFSEP and SFSEP (learned societies)

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Vol 174 - N° 4

P. 255-264 - avril 2018 Retour au numéro

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Recommendations for the use of Rituximab in neuromyelitis optica spectrum disorders - 19/04/18

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