الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 148 |  |  |
| | | from | 148 | | |
Abstract
SUMMARY
N
euromyelitis optica spectrum disorder (NMOSD) is an autoimmune inflammatory disease of the central nervous system with preferential involvement in the optic nerve and spinal cord resulting in long-term disability from incomplete remission of attacks, thus prevention of further relapses is the goal of preventative immunotherapy such as rituximab in NMOSD.
This study was conducted on 25 Egyptian adult patients diagnosed with NMOSD according to the 2015 international consensus diagnostic criteria and receiving rituximab treatment was recruited from the MS unit at the Neurology department in Ain Shams University hospital.
Patients were subjected to clinical assessment including detailed medical history including: Age, gender, residency, risk factors, past history and family history suggesting autoimmune diseases, Detailed history of current illness (NMO) according to MS unit sheet Ain shams university hospital with special emphasis to onset of disease, presenting symptoms, disease progression and response to treatment, General examination and full neurological examination.
Magnetic Resonance Imaging (MRI) of cervical cord, dorsal cord or brain (whether indicated) initial and follow after 12 months. Serum Aquaporin 4 Ab and Visual Evoked Potential, total number of relapses during the course of disease before starting rituximab treatment and Annual relapse rate (ARR) since starting rituximab use. Assessment of functional disability using Expended Disability Status Scale (EDSS). The EDSS is routinely done by the MS units’ consultants and specialists. The EDSS scores were obtained from the patients’ records throughout their illness namely the EDSS scores before and after one year from riruximab.
The current study included twenty five neuromyelitis optica patients that were treated with rituximab ranged from 14 to 62 years old with mean age ±SD 34.40 ± 11.17 and showed nineteen patients (76.0%) were females and six patients (24.0%) were males.
In our study, none of the patients had any other Co-morbid autoimmune diseases, but 2 out of 25 patients (8.0%) had Family history of immune-mediated diseases, one of the patients, her sister had rheumatoid arthritis and the other patient her sister had multiple sclerosis.
Serum Aquaporin 4 Ab test was done to all our 25 patients and was found positive in 19 patients with a total percent of 76.0%.
Out of 25 patients, Visual Evoked Potential was found to be affected in 18 patients (72.0%).
A Comparison between the EDSS before and after treatment with rituximab was illustrated, stating the significance of improvement with rang from 2 – 7.5 to 0 – 7.5.
As regarding magnetic resonance imaging, whether it is the thoracic spine, cervical spine, or the brain, it was of no significance before and after treatment with rituximab.
Out of 25 patients, 24 patient (96.0%) experienced relapses before treatment with rituximab, in contrast to 4 patients (16.0%) experienced relapses after treatment with rituximab.
Description of Clinical improvement regarding EDSS and radiological improvement after to treatment with rituximab, we found that 15 patients (60%) showed improvement in EDSS after treatment with rituximab.
On the other hand, only 11 patients (44 %) showed radiological improvement after treatment with rituximab.
Out of 25 patients, 12 patients developed adverse events after treatment with rituximab, 7 (58.3%) were Aquaporin 4 seropositive patients.
A Comparison between EDSS improvement after treatment with rituximab and seropositive and seronegative Aquaporin 4 patients and also, with the affection of Visual Evoked Potential wasn’t significance (P>0.05).
After 12 months of rituximab treatment, Out of 25 patients, 9 patients (90.0%) with normal MRI brain also showed no improvement in EDSS, 1 patient (10.0%) with ≤ 3 Lesions in MRI brain showed no improvement in EDSS and 1 patient (10.0%) with >3 Lesions in MRI brain showed no improvement in EDSS.
On the other hand, 8 patients (53.3%) with normal MRI brain also showed improvement in EDSS and while 7 patients (46.7%) with ≤ 3 Lesions in MRI brain had improvement in EDSS.
As regarding MRI thoracic spine and EDSS, 8 patients (53.3%) with normal MRI thoracic spine showed significant improvement in EDSS and 7 patients (46.7%) with lesions ≤ 3 segments in MRI thoracic spine showed significant improvement in EDSS.
This review underlines the efficacy and safety of rituximab in NMO. This treatment is widely recognized in this rare disease despite lack of class A evidence from therapeutic trials. However, several questions remain open, including the use of this treatment as a first-line therapy, especially after the first relapse in patients with AQP4-positive antibodies. Finally, larger cohorts of patients are warranted, to better assess the long-term benefit and safety profile, and to define the utility of different biomarkers as surrogate factors of RTX biological activity.