PT -期刊文章盟Stanislas德穆斯AU -尼古拉斯Collongues AU -伯特兰Audoin盟Xavier Ayrignac AU -伯特兰Bourre AU -乔纳森Ciron盟米凯尔·科恩AU -罗曼·德尚AU -弗朗索瓦丝Durand-Dubief AU -伊丽莎白Maillart盟-卡洛琳Papeix盟Aurelie Ruet AU -海琳Zephir盟罗曼Marignier AU -杰罗姆·德·Seze盟NOMADMUS研究小组的TI -利妥昔单抗降级视Neuromyelitis谱系障碍患者援助- 10.1212 / WNL。0000000000207443 DP - 2023年7月25日TA -神经病半岛投注体育官网学PG - e438 e450 VI - 101 IP - 4 4099 - //www.ebmtp.com/content/101/4/e438.short 4100 - //www.ebmtp.com/content/101/4/e438.full所以Neurology2023 7月25日;101 AB -背景和目标退出策略如降级并没有评价利妥昔单抗视neuromyelitis谱系障碍患者(NMOSD)。我们假设他们与疾病相关联而和旨在估计这种风险。方法我们描述一个案件的一系列实际降级从法国NMOSD注册(NOMADMUS)。所有患者遇到了2015年国际面板NMOSD动(IPND)诊断标准诊断。注册表的计算机筛选提取患者利妥昔单抗降级,至少12个月的后续跟踪。我们寻找7降级方案:将中止或切换到口服治疗后注入单周期,将中止或切换到口服治疗周期注入之后,降级在怀孕之前,降级后公差问题,并增加注入间隔。美罗华中止出于无效或未知的目的被排除在外。主要结果的绝对风险NMOSD复活(一个或多个复发)12个月。AQP4 +和AQP4−血清型分别进行了分析。Results We identified 137 rituximab de-escalations between 2006 and 2019 that corresponded to a predefined group: 13 discontinuations after a single infusion cycle, 6 switches to an oral treatment after a single infusion cycle, 9 discontinuations after periodic infusions, 5 switches to an oral treatment after periodic infusions, 4 de-escalations before pregnancies, 9 de-escalations after tolerance issues, and 91 increased infusion intervals. No group remained relapse-free over the whole de-escalation follow-up (mean: 3.2 years; range: 0.79–9.5), except pregnancies in AQP+ patients. In all groups combined and within 12 months, reactivations occurred after 11/119 de-escalations in patients with AQP4+ NMOSD (9.2%, 95% CI [4.7–15.9]), from 0.69 to 10.0 months, and in 5/18 de-escalations in patients with AQP4− NMOSD (27.8%, 95% CI [9.7–53.5]), from 1.1 to 9.9 months.Discussion There is a risk of NMOSD reactivation whatever the rituximab de-escalation regimen.Trial Registration Information Registered on ClinicalTrials.gov: NCT02850705.Classification of Evidence This study provides Class IV evidence that de-escalation of rituximab increases the probability of disease reactivation.AQP4-IgG=aquaporin 4-IgG; EDSS=Expanded Disability Status Scale; MOGAD=myelin oligodendrocyte glycoprotein antibody disease; MOG-IgG=myelin oligodendrocyte glycoprotein antibodies; MS=multiple sclerosis; NMOSD=neuromyelitis optica spectrum disorder; RCTs=randomized clinical trials

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