The Use of Rituximab in Neurological Diseases; Real World Data from a Neuroscience Centre (2575)

Objective: To audit the use of Rituximab (RTX) in neurological diseases, after the establishment of a multidisciplinary team (MDT) panel Background: In the UK, the use of RTX for managing neuroinflammatory conditions is not regulated by guidelines and therefore remains unlicensed, restricting its availability. In 2017, at Imperial College Healthcare Trust an MDT panel, with peripheral nerve, epilepsy, neuroinflammatory experts and a neuropharmacist, was set up to establish appropriate indications for RTX and to ensure homogeneous administration Design/Methods: We collected data on patients treated with RTX from April 2018 to October 2019 and followed for 16.7 mean months Results: After the MDT panel inception, 8 patients were rejected, while 30 patients received RTX. Females predominated (63.3%; n=19) and the mean age at disease onset was 39.0 years (range=14–75). At first RTX dose, the mean age was 45.1 years (range=23–75) and the mean disease duration was 62.4 months (range=0–317). Most patients (60%; n=18) had previously failed other immunosuppressive therapies. The most common diagnoses were autoimmune encephalitis (36.7%; n=11), cerebral vasculitis (23.3%; n=7) and myasthenia (16.7%, n=5). Overall, 21 patients (70%) showed positive treatment response. The highest proportion of responders was observed, among patients with myasthenia (100%; strength improvement), autoimmune encephalitis (81.8%; reduced seizures frequency) and cerebral vasculitis (28.6%; no further stroke). We also successfully treated with RTX patients affected by Stiff-person syndrome (n=2), myopathy (n=1) CANOMAD (n=1), and Sjogren’s (n=1), although two patients, with CIDP and with relapsing central nervous system neuroinflammatory disorder, did not respond to the therapy. No severe side effects were recorded and only 15 (47%) patients experienced infusion reactions (13%; n=5) and infections (23%; n=10). Conclusions: The introduction of the MDT panel allowed to safely and successfully deliver RTX, among patients with a range of neurological conditions. We propose the implementation of this model of care to ensure consistency of administration. Disclosure: Dr. Kondratiuk has nothing to disclose. Dr. Muraro has nothing to disclose. Dr. Johnson has nothing to disclose. Dr. Sing-Curry has nothing to disclose. Dr. Pritchard has nothing to disclose. Dr. Dorsey has nothing to disclose. Dr. Nicholas has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Biogen, Roche, Novartis. Dr. Nicholas has received research support from Biogen, Novartis and Roche. Dr. Scalfari has nothing to disclose.