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Comparison of two individualized administration schemes of rituximab based on memory B cells monitoring in AQP4 positive disorder

Abstract : Background: Individualized dosing schedule of rituximab based of memory B-cells count has been demonstrated to be safe and effective for the treatment of patients with AQP4-antibody disorder. Objective: To compare the efficacy of two different individualized administration schemes of rituximab for the treatment of patients with AQP4-antibody disorder. Design/Methods: Adult patients with AQP4-antibody disorder treated with rituximabat the Multiple Sclerosis Center of Marseillewere included in a prospective observational study. Patients were treated using an individualized dosing schedule adapted to the biological effect of rituximab monitored by monthly memory B-cells counts. Between January 2012 and August 2016, rituximab re-infusion was performed only when memory B-cells reached 0.05% of the peripheral blood mononuclear cells ('original scheme'). Becauserelapses occurred after 6 months in several patients, we decided in August 2016 to optimize the protocol. Before 6 months, patients were re-treated if memory B-cells reached the threshold of 0.05%. At 6 months, patients were re-treated regardless of the level of memory B-cells if memory B-cells had not reemerged before ('optimized scheme'). Annual relapse rates were compared between the two administration schemes. Only data of patients treated during at least one year using one of the two schemes were included in the analysis.Results: Fifteen patients were treated using the 'original scheme' during at least one year (mean duration: 28 months (13 - 55)). In these patients mean annual relapse rate was 0.35 (0-1.6). Twenty-nine patients were treated using the 'optimized scheme' during at least one year (mean duration 22 months (13 - 25)). In these patients mean annual relapse rate was 0.04 (0-0.7). In patients first treated with the 'original scheme' and secondly with the 'optimized scheme' (n=15) relapse rate decreased from 0.35 (0-1.6) to 0 (p< 0.001). Conclusions: Compared to the non-individualized classical 6 months rituximab administration scheme, the present individualized 'optimized scheme' enables to detect rapid reemergence of memory B-cells before 6 months without the risk of relapse after 6 months inherent to the individualized 'original scheme'.
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Poster
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https://hal.inrae.fr/hal-02894117
Déposant : Nelly Lucas <>
Soumis le : mercredi 8 juillet 2020 - 17:32:42
Dernière modification le : jeudi 26 novembre 2020 - 12:22:08

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Pierre Durozard, Alain Rico, C. Boutière, A. Maarouf, R. Lacroix, et al.. Comparison of two individualized administration schemes of rituximab based on memory B cells monitoring in AQP4 positive disorder. ECTRIMS 2019 Congress, Sep 2019, Stockholm, Sweden. ECTRIMS Online Library. ⟨hal-02894117⟩

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