Study On The Optimized Regimen Of Low-dose Rituximab In The Treatment Of Neuromyelitis Optica Spectrum Diseases

Objective: Compare the efficacy and safety differences among three low-dose rituximab(RTX)treatments for neuromyelitis optica spectrum disease(NMOSD),observe the effects of the three treatment regimens on B cells and anti-rituximab antibody(ARA).Optimize the regimen of low-dose rituximab in the treatment of neuromyelitis optica spectrum diseases.Methods: A collection of patients diagnosed with NMOSD in our hospital from January 2015 to December 2020 were divided into three groups.The induction treatment regimen was 100 mg each week for three weeks in group A,and 100 mg each day continuous for three days in group B,300 mg for one day in group C.The proportion of CD19+B cells in peripheral blood to PBMC was monitored every 6-9 months,and RTX treatment with the same induction dose was given when the proportion was less than 1%.Analyze the changes of ARR,EDSS scores,and the number of MRI T2 lesions before and after treatment in the three groups to evaluate the effectiveness of the treatment,observe the adverse reactions of the three groups to evaluate its safety;monitor the proportion of CD19+B cells and CD27+memory B cells in PBMC to evaluate the exhaustion situation of B cell.Detect the ARA production of the three groups of patients and analyze the differences.Results:A total of 53 patients were included in the study.There were 17 patients in group A,14(82.3%)of them had no recurrence after treatment,21 patients in group B,15(71.4%)of them had no recurrence after treatment,and 15 patients in group C,11(73.3%)of them had no recurrence after treatment.There was statistically significant differences in the reduction of ARR,EDSS score,and the number of MRI T2 lesions before and after treatment in three groups(P <0.05).There was no significant difference in reduction of ARR,EDSS score and MRI T2 lesion number among the three groups.There were no serious adverse reactions in the three groups.The more common adverse reaction was infusion reaction.One patient in group B and C had a severe infusion reaction,which was characterized by systemic hypersensitivity and discontinued RTX treatment.There was no statistically significant difference in the proliferation time of CD19+B cells and CD27+memory B cells among the three groups.The proliferation time of CD27+memory B cells was generally shorter than that of CD19+B cells.In this study,a total of 23 patients in 3 groups were tested for ARA,7(30.4%)of them were positive.Group C had the lowest ARA positive rate(12.5%).The production of ARA had no significant effect on the efficacy and safety of low-dose RTX treatment.There was no significant difference in ARA concentration among the three groups.Conclusion: Low-dose RTX treatment of NMOSD is effective in controlling recurrence and improving patients’ disability symptoms.There is no significant difference in the reduction of ARR,EDSS scores,and MRI T2 lesions among the three groups.The three groups of application regimens are safe and no serious adverse reactions occurred.Choosing the treatment plan of group B or C is conducive to improving patient compliance and economic and social benefits.In terms of medication monitoring,more attention should be paid to the monitoring of CD27+ memory B cells while monitoring CD19+B cells to avoid recurrence due to insufficient monitoring.