A real-world study on the long-term efficacy of rituximab in relapsing myelin oligodendrocyte glycoprotein antibody-associated disease

OBJECTIVE: Data on the long-term efficacy and safety of rituximab (RTX) in myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) are scarce. The potential for a relapsing-remitting disease course in patients with MOGAD also requires further investigation. The study aimed to evaluate the long-term clinical outcomes in relapsing MOGAD patients receiving RTX maintenance therapy.

METHODS: A retrospective analysis was performed on MOGAD patients. Clinical features, relapse frequency, and Expanded Disability Status Scale (EDSS) scores were evaluated pre- and post-administration of 0.5g RTX.

RESULTS: Thirty-five MOGAD patients who met inclusion criteria were identified with a median RTX duration of 1.25 (0.5-4) years. RTX reduced both annualized relapse rate (ARR) (from 1.64 to 0.1; P <0.0001) and person-year relapse rate (PRR) (from 0.61 to 0.12). 74 % (26/35) of patients remained relapse-free; 26 % (9/35) experienced relapses, of whom 78 % (7/9) had B-cell repopulation or discontinuation of RTX maintenance treatment. Most relapsing patients had mild clinical symptoms, with mean EDSS scores increasing to 1.65 (range, 1-4). All patients who reinfused ≥2 RTX after relapse remained relapse-free. Seroconversion to MOG-IgG negativity occurred in 43 % (15/35), with 6 patients exhibiting recurrent seropositivity, and 3 of whom experienced relapses. Three patients who discontinued RTX after seroreversion maintained relapse-free status. Importantly, no serious adverse events were observed, except that three patients suffered from infection or a rash during infusion.

CONCLUSION: RTX treatment is associated with lower recurrence rates and high seroconversion rates in MOGAD patients. Post-treatment relapses did not exacerbate disability severity, supporting RTX as a favorable therapeutic option to prevent relapse.