Indications and Safety of Rituximab in Pediatric Neurology: A 10-Year Retrospective Study

Ai Tien Nguyen; Camille Cotteret; Chloé Durrleman; Christine Barnerias; Marie Hully; Cyril Gitiaux; Bettina Mesples; Jacinta Bustamante; Stéphanie Chhun; Claire Fayard; Salvatore Cisternino; Jean-Marc Treluyer; Isabelle Desguerre; Mélodie Aubart

doi:10.1016/j.pediatrneurol.2022.08.004

Indications and Safety of Rituximab in Pediatric Neurology: A 10-Year Retrospective Study

Pediatr Neurol. 2022 Dec:137:41-48. doi: 10.1016/j.pediatrneurol.2022.08.004. Epub 2022 Sep 15.

Affiliations

¹ Department of Pediatric Neurology, Necker-Enfants malades Hospital, University of Paris, AP-HP, Paris, France.
² Department of Clinical Pharmacy, Necker-Enfants malades Hospital, University of Paris, AP-HP, Paris, France.
³ Department of Pediatrics, Louis Mourier Hospital, University of Paris, AP-HP, Paris, France.
⁴ Study Center for Primary Immunodeficiencies, Necker-Enfants malades Hospital, University of Paris, AP-HP, Paris, France; Human Genetics of Infectious Diseases, INSERM UMR 1163, University of Paris, Institut Imagine, Paris, France.
⁵ Laboratory of Immunology, Necker-Enfants malades Hospital, University of Paris, AP-HP, Paris, France.
⁶ Clinical Research Unit, Necker-Enfants maladies Hospital, University of Paris, AP-HP, Paris, France.
⁷ Department of Pediatric Neurology, Necker-Enfants malades Hospital, University of Paris, AP-HP, Paris, France; Human Genetics of Infectious Diseases, INSERM UMR 1163, University of Paris, Institut Imagine, Paris, France. Electronic address: melodie.aubart@aphp.fr.

PMID: 36228496
DOI: 10.1016/j.pediatrneurol.2022.08.004

Abstract

Background: RTX is used off-label in several neurological inflammatory diseases in adults children patients. We conducted a study to assess indications and safety of rituximab (RTX) for children and to identify risk factors for early B-cell repopulation.

Methods: A single-center retrospective study of children treated with RTX for a neurological disease between May 31, 2010, and May 31, 2020, was performed.

Results: A total of 77 children (median age, 8.9 years) were included. RTX was mostly used as second-line therapy in all groups of diseases (68%). Median dose was 1500 mg/m² for each patient. There were 13 clinical relapses (17%), 5 when B-cell depletion was complete. Adverse events were present in 6% of the cases. The factors influencing early B-cell repopulation were the recent infusion of intravenous Ig (P < 0.01) and the administration of less than 1500 mg/m² during the first RTX treatment (P = 0.04). The median time to B-cell repopulation seemed to be shorter (160 vs 186 days) when patients had plasmapheresis even when a 48-hour delay was observed with RTX infusions.

Conclusions: This study confirms the good tolerance of RTX in the treatment of specific neurological disorders in a pediatric population. It also highlights risk factors for early B-cell repopulation and underlines the importance of B-cell monitoring.

Keywords: B lymphocytes; Encephalitis; Neuromyelitis optica; Rituximab.

MeSH terms

Adult
B-Lymphocytes*
Child
Humans
Immunologic Factors / therapeutic use
Neurology*
Retrospective Studies
Rituximab / adverse effects
Treatment Outcome

Substances

Rituximab
Immunologic Factors