Treatment of MOG-IgG-associated disorder with rituximab: An international study of 121 patients

Daniel H. Whittam, Alvaro Cobo-Calvo, A. Sebastian Lopez-Chiriboga, Santiago Pardo, Matthew Gornall, Silvia Cicconi, Alexander Brandt, Klaus Berek, Thomas Berger, Ilijas Jelcic, Grace Gombolay, Luana Micheli Oliveira, Dagoberto Callegaro, Kimihiko Kaneko, Tatsuro Misu, Marco Capobianco, Emily Gibbons, Venkatraman Karthikeayan, Bruno Brochet, Bertrand AudoinGuillaume Mathey, David Laplaud, Eric Thouvenot, Mikaël Cohen, Ayman Tourbah, Elisabeth Maillart, Jonathan Ciron, Romain Deschamps, Damien Biotti, Kevin Rostasy, Rinze Neuteboom, Cheryl Hemingway, Rob Forsyth, Marcelo Matiello, Stewart Webb, David Hunt, Katy Murray, Yael Hacohen, Ming Lim, M. Isabel Leite, Jacqueline Palace, Tom Solomon, Andreas Lutterotti, Kazuo Fujihara, Ichiro Nakashima, Jeffrey L. Bennett, Lekha Pandit, Tanuja Chitnis, Brian G. Weinshenker, Brigitte Wildemann, Douglas Kazutoshi Sato, Su Hyun Kim, Saif Huda, Ho Jin Kim, Markus Reindl, Michael Levy, Sven Jarius, Silvia Tenembaum, Friedemann Paul, Sean Pittock, Romain Marignier, Anu Jacob

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71 Citations (Scopus)


Objective: To assess the effect of anti-CD20 B-cell depletion with rituximab (RTX) on relapse rates in myelin oligodendrocyte glycoprotein antibody-associated disorder (MOGAD). Methods: Retrospective review of RTX-treated MOGAD patients from 29 centres in 13 countries. The primary outcome measure was change in relapse rate after starting rituximab (Poisson regression model). Results: Data on 121 patients were analysed, including 30 (24.8%) children. Twenty/121 (16.5%) were treated after one attack, of whom 14/20 (70.0%) remained relapse-free after median (IQR) 11.2 (6.3–14.1) months. The remainder (101/121, 83.5%) were treated after two or more attacks, of whom 53/101 (52.5%) remained relapse-free after median 12.1 (6.3–24.9) months. In this ‘relapsing group’, relapse rate declined by 37% (95%CI=19–52%, p<0.001) overall, 63% (95%CI=35–79%, p = 0.001) when RTX was used first line (n = 47), and 26% (95%CI=2–44%, p = 0.038) when used after other steroid-sparing immunotherapies (n = 54). Predicted 1-year and 2-year relapse-free survival was 79% and 55% for first-line RTX therapy, and 38% and 18% for second-/third-line therapy. Circulating CD19+B-cells were suppressed to <1% of total circulating lymphocyte population at the time of 45/57 (78.9%) relapses. Conclusion: RTX reduced relapse rates in MOGAD. However, many patients continued to relapse despite apparent B-cell depletion. Prospective controlled studies are needed to validate these results.

Original languageEnglish
Article number102251
JournalMultiple Sclerosis and Related Disorders
Publication statusPublished - 2020 Sept
Externally publishedYes


  • MOG
  • Myelin oligodendrocyte glycoprotein
  • Neuromyelitis optica
  • Optic neuritis
  • Rituximab

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology


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