Comparative Evaluation of Rituximab Versus Approved Therapies in Aquaporin-4-IgG-Positive Neuromyelitis Optica Spectrum Disorder: A Systematic Review and Network Meta-analysis.

IF 4.7 3区医学 Q1 CLINICAL NEUROLOGY

Neurology and Therapy Pub Date : 2026-10-01 Epub Date: 2026-07-16 DOI:10.1007/s40120-026-00989-x

Mahdi Barzegar, Sara Samadzadeh, Bertrand Audoin, Achim Berthele, Ayse Altintas, Barbara Willekens, Sini Laakso, Shima Jahani, Viktoria Papp, Clarissa Zappe, Antonia Lefter, Aksel Siva, Alireza Afshari-Safavi, Sören Möller, Beatrijs Wokke, Rosa Cortese, Zsolt Illes, Saif Huda, Rommer Paulus, Silvia Messina, Nicolas Collongues, Marius Ringelstein, Álvaro Cobo-Calvo, Yael Hacohen, Georgina Arrambide, Jacqueline Palace, Sara Mariotto, Romain Marignier, Ruth Geraldes, Friedemann Paul, Nasrin Asgari

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引用次数: 0

Abstract

Introduction: Neuromyelitis optica spectrum disorder (NMOSD) is a rare antibody-mediated neuro-autoimmune disease. Monoclonal antibodies targeting B cell antigens CD19 and CD20, the interleukin-6 receptor, or the complement cascade are used as preventive therapies to reduce relapse rates. We conducted a network meta-analysis (NMA) to compare the effect of rituximab on time to first relapse with ravulizumab, eculizumab, inebilizumab, and satralizumab in patients with NMOSD who are aquaporin-4 (AQP4)-IgG-positive.

Methods: A systematic search was conducted in PubMed, Scopus, CINAHL, EMBASE, Web of Science, the Cochrane Library, and gray literature sources up to October 31, 2024, and updated on November 1, 2025, following PRISMA guidelines. A network meta-analysis of randomized and open-label trials was conducted to compare time to first relapse between rituximab and other monoclonal antibody therapies.

Results: From 6337 records, 3825 duplicates were removed; 2512 were screened, 2327 excluded, leaving eight trials. The prior treatment, relapse history, and definitions and adjudication of relapse varied across studies. Rituximab showed higher hazard ratio (HR) point estimates for time to first relapse compared with ravulizumab with or without immunosuppressive therapies (IST) (HR 5.00, 95% CI 0.25, 101.01) and eculizumab ± IST (HR 1.17, 95% CI 0.12, 10.89), but were lower compared with satralizumab ± IST (HR 0.29, 95% CI 0.04, 2.23). In patients not receiving IST, rituximab showed numerically higher HR compared with ravulizumab (HR 3.33, 95% CI 0.13, 83.16) and eculizumab (HR 1.59, 95% CI 0.05, 50.17), but lower point estimates compared with inebilizumab (HR 0.31, 95% CI 0.04, 2.31) and satralizumab (HR 0.27, 95% CI 0.03, 2.21).

Conclusion: This NMA showed hazard ratio point estimates favoring eculizumab and ravulizumab over rituximab. However, wide, overlapping confidence intervals and between-study heterogeneity indicate substantial uncertainty. Head-to-head trials or registry-based studies are needed to determine the most effective treatment for AQP4-IgG-positive NMOSD.

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利妥昔单抗与批准的治疗水通道蛋白-4- igg阳性视谱神经脊髓炎的比较评价：系统评价和网络荟萃分析。

简介：视神经脊髓炎谱系障碍（NMOSD）是一种罕见的抗体介导的神经自身免疫性疾病。针对B细胞抗原CD19和CD20、白细胞介素-6受体或补体级联的单克隆抗体被用作预防治疗以减少复发率。我们进行了一项网络荟萃分析（NMA），比较利妥昔单抗与ravulizumab、eculizumab、inebilizumab和satralizumab在水通道蛋白-4 (AQP4)- igg阳性的NMOSD患者中首次复发的时间影响。方法：系统检索PubMed、Scopus、CINAHL、EMBASE、Web of Science、Cochrane Library和灰色文献，检索时间截止到2024年10月31日，更新时间为2025年11月1日，遵循PRISMA指南。一项随机和开放标签试验的网络荟萃分析进行了比较，利妥昔单抗和其他单克隆抗体治疗的首次复发时间。结果：6337条记录中，剔除重复3825条；2512项被筛选，2327项被排除，剩下8项试验。既往治疗、复发史、复发的定义和判定在不同的研究中有所不同。与拉乌利珠单抗联合或不联合免疫抑制治疗（IST）相比，利图昔单抗首次复发时间的风险比（HR）点估计更高（HR 5.00, 95% CI 0.25, 101.01）和埃曲利珠单抗±IST (HR 1.17, 95% CI 0.12, 10.89)，但与萨特利珠单抗±IST相比（HR 0.29, 95% CI 0.04, 2.23）。在未接受IST治疗的患者中，利妥昔单抗的HR数值高于ravulizumab （HR 3.33, 95% CI 0.13, 83.16）和eculizumab (HR 1.59, 95% CI 0.05, 50.17)，但与inebilizumab （HR 0.31, 95% CI 0.04, 2.31）和satralizumab （HR 0.27, 95% CI 0.03, 2.21）相比，HR值较低。结论：该NMA显示的风险比点估计值有利于埃曲单抗和拉乌利单抗优于利妥昔单抗。然而，广泛、重叠的置信区间和研究间的异质性表明存在很大的不确定性。为了确定aqp4 - igg阳性NMOSD的最有效治疗方法，需要进行头对头试验或基于注册的研究。

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来源期刊

Neurology and Therapy CLINICAL NEUROLOGY-

CiteScore

5.40

自引率

8.10%

发文量

103

审稿时长

6 weeks

期刊介绍： Aims and Scope Neurology and Therapy aims to provide reliable and inclusive, rapid publication for all therapy related research for neurological indications, supporting the timely dissemination of research with a global reach, to help advance scientific discovery and support clinical practice. Neurology and Therapy is an international, open access, peer reviewed, rapid publication journal dedicated to the publication of high-quality clinical (all phases), observational, real-world and health outcomes research around the discovery, development, and use of neurological and psychiatric therapies, (also covering surgery and devices). Studies relating to diagnosis, pharmacoeconomics, public health, quality of life, and patient care, management, and education are also welcomed. The journal is of interest to a broad audience of healthcare professionals and publishes original research, reviews, case reports, trial designs, communications and letters. 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