J Clin Neurol.
2025 Mar;21(2):131-136. 10.3988/jcn.2024.0485.
Evaluating Rituximab Failure Rates in Neuromyelitis Optica Spectrum Disorder: A Nationwide Real-World Study From South Korea
- Kim SH
1 - Min JH2
- Kim SM3
- Lee EJ4
- Lim YM4
- Shin HY5
- Kwon YN5
- Sohn E6
- Kim S6
- Park MS7
- Nam TS8
- Yoon BA9
- Kim JK9
- Shin KJ10
- Kim YH11
- Seok JM12
- Bong JB13
- Kim S14
- Seok HY14
- Oh SY15
- Kwon O16
- Kim S17
- Lee S18
- Kim NH19
- Cho EB20
- Kang SY21
- Oh Si22
- Bae JS23
- Ahn SW24
- Kim KH1,25
- Kang YR1
- Ju W3
- Choo SH2
- Chung YH2,26
- Hyun JW1
- Kim HJ1
- Affiliations
-
- 1Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang, Korea
- 2Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- 3Department of Neurology, Seoul National University College of Medicine, Seoul, Korea
- 4Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- 5Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
- 6Department of Neurology, Chungnam National University of Hospital, Chungnam National University College of Medicine, Daejeon, Korea
- 7Parkminsu Neurology Clinic, Daegu, Korea
- 8Department of Neurology, Chonnam National University Hospital, Gwangju, Korea
- 9Department of Neurology, Dong-A University College of Medicine, Busan, Korea
- 10Department of Neurology, Haeundae-Paik Hospital, Inje University, College of Medicine, Busan, Korea
- 11Department of Neurology, Hallym University Sacred Heart Hospital, College of Medicine, Hallym University, Anyang, Korea
- 12Department of Neurology, Soonchunhyang University Hospital Cheonan, Soonchunhyang University College of Medicine, Cheonan, Korea
- 13Department of Neurology, Chosun University Hospital, Gwangju, Korea
- 14Department of Neurology, Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea
- 15Department of Neurology, Jeonbuk National University Hospital, Jeonju, Korea
- 16Department of Neurology, Uijeonbu Eulji Medical Center, Eulji University School of Medicine, Uijeongbu, Korea
- 17Department of Neurology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
- 18Department of Neurology, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
- 19Department of Neurology, Dongguk University Ilsan Hospital, Goyang, Korea
- 20Department of Neurology, Gyeongsang National University Changwon Hospital, Gyeongsang National University, Jinju, Korea
- 21Department of Neurology, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea
- 22Department of Neurology, Kyung Hee University Medical Center, Seoul, Korea
- 23Department of Neurology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
- 24Department of Neurology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
- 25Department of Neurology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
- 26Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
- KMID: 2565546
- DOI: http://doi.org/10.3988/jcn.2024.0485
Abstract
- Background and Purpose
Treatments for neuromyelitis optica spectrum disorder (NMOSD) such as eculizumab, ravulizumab, satralizumab, and inebilizumab have significantly advanced relapse prevention, but they remain expensive. Rituximab is an off-label yet popular alternative that offers a cost-effective solution, but its real-world efficacy needs better quantification for guiding the application of newer approved NMOSD treatments (ANTs). This study aimed to determine real-world rituximab failure rates to anticipate the demand for ANTs and aid in resource allocation.
Methods
We conducted a nationwide retrospective study involving 605 aquaporin-4-antibody-positive NMOSD patients from 22 centers in South Korea that assessed the efficacy and safety of rituximab over a median follow-up of 47 months.
Results
The 605 patients treated with rituximab included 525 (87%) who received continuous therapy throughout the follow-up period (median=47 months, interquartile range=15–87 months). During this period, 117 patients (19%) experienced at least 1 relapse. Notably, 68 of these patients (11% of the total cohort) experienced multiple relapses or at least 1 severe relapse. Additionally, 2% of the patients discontinued rituximab due to adverse events, which included severe infusion reactions, neutropenia, and infections.
Conclusions
This study has confirmed the efficacy of rituximab in treating NMOSD, as evidenced by an 87% continuation rate among patients over a 4-year follow-up period. Nevertheless, the occurrence of at least one relapse in 19% of the cohort, including 11% who experienced multiple or severe relapses, and a 2% discontinuation rate due to adverse events highlight the urgent need for alternative therapeutic options.
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