The Effectiveness Of Rituximab Treatment In Neuromyelitis Optica And Neuromyelitis Optica Spectrum Disorders

Objective:To discussion the better therapeutic schedule of rituximab treatment in neuromyelitis optica and neuromyelitis optica spectrum disorders.Methods:12 NMO patients which came from Department of Neurology First Hospital of ShanXi Medical University from 2012 to 2016 were enrolled in this study.Medical history,clinical symptoms,the course of treatment,family history and autoimmune disease were recorded.Intramuscular injection for diphenhydramine and oral Ibuprofen were necessary before the intravenous rituximab.When rituximab was by intravenous drip,driping speed was 50mg/h at the beginning.Driping speed increased by 50mg/h every 30 minute,the upper limit of driping speed was 300mg/h.Electrocardiogram monitoring system was needed when rituximab was by intravenous drip. B lymphocyte subsets was monitored when 4 weeks after the treatment.Immune globulin,liver and renal function, B lymphocyte subsets were tested before the treatment for the first intravenous drip of rituximab and the fourth intravenous drip for rituximab.Magnetic Resonance Imaging for head and B lymphocyte subsets were tested every 8 weeks by the clinical laboratory,radiology department and research centres.12 patients were divided into 2 groups.B lymphocyte subsets were tested before the treatment for intravenous drip of rituximab in the experimental group,when CD19+B lymphocyte cell counts was greater than 1%, intravenous drip of rituximab was gived. Intravenous drip of rituximab was gived every 6 months in the control group. Expanded Disability Status Scale,lesions in the MRI,follow-up times were recorded. Expanded Disability Status Scale and lesions in the head were designed for data analysis.Results:1.According to the CD19+ lymphasite cell ratio, during the first relive period, theEDSS of 375mg/m2 rituximab therapy group scored higher than the control group,which had a significant diffierence.2.According to the CD19+ lymphasite cell ratio, during the consequential therapy period, the number of local pathology in MRI significantly decreased in 375mg/m2 rituximab therapy group, compared to control group.3. The last time EDSS of 375mg/m2 rituximab therapy group during the folowing up scored lower than baseline EDSS for patients without treatment.4.The number of local pathology in MRI significantly decreased in 375mg/m2 rituximab consequential therapy of 6 months, compared to control group.5.According to the CD19+ lymphasite cell ratio, during the consequential therapy of 6 months period, the degree of EDSS score of 375mg/m2 rituximab therapy group declined greater than the 375mg/m2 rituximab consequential therapy of 6 months.6.The number of local pathology in MRI significantly decreased in 375mg/m2 rituximab therapy group based on the CD19+ lymphasite cell ratio, compared to the375mg/m2 rituximab therapy group based on consequential therapy of 6 months period.Conclusions:1.According to the CD19+ lymphasite cell ratio, during the first relive period, the EDSS of 375mg/m2 rituximab therapy group scored higher than the control group,which had a significant diffierence. It dictated that standard rituximab therapy based on the CD19+ lymphasite cell ratio can significantly decreased the NMO and NMOSD score, and improve the defection of clinical manefestation of patients.2.According to the CD19+ lymphasite cell ratio, during the consequential therapyperiod, the number of local pathology in MRI significantly decreased in 375mg/m2 rituximab therapy group, compared to control group.This suggested that rituximab therapy based on the CD19+ lymphasite cell ratio can significantly decreased the number of local pathology in MRI for NMO and NMOSD patients.3.The last time EDSS of 375mg/m2 rituximab therapy group during the folowing up scored lower than baseline EDSS for patients without treatment.It suggested that rituximab therapy 6 months periodically can decreace the EDSS score of NMO and NMOSD patients, and played an effective impact on the central nervous system manifestation.4. The last time EDSS of 375mg/m2 rituximab therapy group during the folowing up scored lower than baseline EDSS for patients without treatment.It suggested that rituximab therapy 6 months periodically can decreace the number of local pathology in MRI for NMO and NMOSD patients.5.According to the CD19+ lymphasite cell ratio, during the consequential therapy of 6 months period, the degree of EDSS score of 375mg/m2 rituximab therapy group declined greater than the 375mg/m2 rituximab consequential therapy of 6 months. It denoted that rituximab therapy based on the CD19+ lymphasite cell ratio can significantly decreased the number of local pathology in MRI for NMO and NMOSD patients, compared rituximab therapy 6 months periodically.6.The number of local pathology in MRI significantly decreased in 375mg/m2 rituximab therapy group based on the CD19+ lymphasite cell ratio, compared to the375mg/m2 rituximab therapy group based on consequential therapy of 6 months period.It suggested that rituximab therapy based on the CD19+ lymphasite cell ratio can significantly decreased the number of local pathology in MRI for NMO and NMOSD patients.