Abstract Details

Title Prolonged Remission in Two NMO Patients after Rituximab Discontinuation: Induction of Tolerance?

Topic MS and Related Diseases

Presentation(s) P02 - (-)

Poster/Presentation
Number 142

Objective

Background BACKGROUND: NMO is an autoimmune demyelinating condition characterized by acute episodes of transverse myelitis and optic neuritis. Rituximab is a monoclonal antibody against CD20 on B-lymphocytes and has some efficacy in preventing relapses of NMO; however, there is no consensus on how long, and if, maintenance doses are necessary.

Design/Methods DESIGN/METHODS: Two case reports.

Results RESULTS: The first patient was diagnosed with NMO at 49 years old. She suffered two severe episodes of complete transverse myelitis and one of optic neuritis within the first year. Each episode was treated with pulse steroids. She was then started on rituximab and received a total of two grams from three yearly cycles. During treatment, the patient experienced no further exacerbations. She chose to discontinue treatment and has been clinically and radiologically stable off therapy for the last eight years. The second patient was diagnosed with NMO when he was 9 years old. He experienced three severe demyelinating episodes within the first nine months, involving the spinal cord, brainstem, optic nerves, and cerebrum. All episodes were treated with pulse steroids. He was then started on rituximab and received five total courses, each six months apart. The first course was two infusions of 250 mg two weeks apart; however, subsequent treatments were increased to two 500 mg infusions, following which the patient experienced no further exacerbations. His parents requested discontinuing rituximab treatment to determine whether he could remain stable off therapy. His last infusion was 18 months ago, and his B cell counts have been back to normal for over a year. He has continued to remain clinically and radiologically stable off treatment.

Conclusions CONCLUSIONS: These two cases question whether B cell depletion with rituximab may induce prolonged remission in some patients with NMO.

Authors/Disclosures
PRESENTER	No disclosure on file
Emmanuelle Waubant, MD, PhD, FAAN (USCF MS Center)	The institution of Dr. Waubant has received research support from NIH. The institution of Dr. Waubant has received research support from NMSS. The institution of Dr. Waubant has received research support from PCORI. The institution of Dr. Waubant has received research support from Race to Erase MS. The institution of Dr. Waubant has received research support from Roche. The institution of Dr. Waubant has received research support from Department of Defense. Dr. Waubant has received publishing royalties from a publication relating to health care.
Eddie Jones, BA	Eddie Jones, BA has nothing to disclose.

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