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Master Thesis

Efficacité du RITUXIMAB en fonction du sous-type d’anticorps dans le spectre des neuromyélites optiques en Nouvelle Aquitaine. Apport d'une corticothérapie adjuvante au RITUXIMAB.

Abstract : Background. The use of anti-CD20 antibodies (RITUXIMAB (RTX)) has been shown to be effective in preventing recurrence of relapses and decreasing disability in the neuromyelitis optica spectrum disorder (NMOSD), particularly in seropositive forms for aquaporin-4 antibodies (AQP4+). In myelin oligodendrocyte glycoprotein antibody disease (MOGAD), there is no consensus on the background treatment and the effectiveness of anti-CD20 is debated. Objective. The primary objective is to compare the clinical efficacy of RTX on relapse risk and disability reduction in NMOSD AQP4+ and MOGAD. The secondary objective is to investigate the efficacy of corticosteroid add-on therapy with RTX in NMOSD. Method. This is a multicentric retrospective study including population of adult patients with NMOSD (AQP4+, MOG+ and double seronegative) in Nouvelle-Aquitaine. The primary endpoint was to compare the time to first relapse after the start of RTX between the NMOSD AQP4+ group and MOGAD group , using survival analysis. The secondary endpoints were changes in the annual relapse rate (ARR) and Expanded Disability Status Scale (EDSS) based on the antibody subtype, as well the intake of corticosteroid add-on therapy with RTX on the risk of relaps. Results. Forty-one NMOSD patients were included: 17 AQP4+, 19 MOG+ and 5 double seronegative. There is no significant difference in the time to first relapse after RTX treatment between the NMOSD AQPQ4+ group and MOGAD (p = 0.51). At 1 year and 2 years of follow-up, respectively 94.1% and 69% of patients were free of relapse in the AQP4+ group; 84% and 66.7% in the MOG+ group. In the MOGAD group, the mean ARR decreases significantly after the onset of RTX (ARR the previous year at 1.95, compared to ARR the first year at 0.16, and the second year at 0.30). MOGAD also improve their disability during follow-up with a decrease in EDSS. Regarding the efficacy of corticosteroids, there is no significant difference in the time to first relaps between the group of NMOSD patients with high dose RTX add-on corticosteroids and those receiving RTX alone. Conclusion. The clinical efficacy of RTX in terms of relapse prevention and disability reduction was not different in patients in the NMOSD AQP4+ group and those in the MOGAD group in our study. Our results also suggest the lack of efficacy of corticosteroid add-on therapy with RTX on the risk of relaps at the start of treatment in NMOSD patients.
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Louis Carla. Efficacité du RITUXIMAB en fonction du sous-type d’anticorps dans le spectre des neuromyélites optiques en Nouvelle Aquitaine. Apport d'une corticothérapie adjuvante au RITUXIMAB.. Sciences du Vivant [q-bio]. 2019. ⟨dumas-02442771⟩

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