Multiple Sclerosis

Tocilizumab and Rituximab Reduce Relapse Rates, Disability in NMOSD

Hibah Khaja, PharmD
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Publish Date
Compared with prednisolone, both tocilizumab and rituximab significantly reduced relapse risk in patients with AQP4-IgG+ NMOSD.

Among patients with neuromyelitis optica spectrum disorder (NMOSD), tocilizumab and rituximab lead to significant reductions in relapse rates and disability progression while tocilizumab offers additional benefits in myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD). These are the findings of a study presented at the Americas Committee for Treatment and Research in Multiple Sclerosis (ACTRIMS) Forum 2025, held in West Palm Beach, Florida from February 27 to March 1.

Researchers conducted a retrospective comparative analysis of 163 patients with aquaporin-4 immunoglobulin G-seropositive (AQP4-IgG+) NMOSD and 26 patients with MOGAD who were treated with tocilizumab, rituximab, or prednisolone between January 1, 2017, and January 1, 2022.

Clinical outcomes assessed included individual relapse rates, annualized relapse rate (ARR), Expanded Disability Status Scale (EDSS) scores, and adverse events (AEs).

Compared with prednisolone, both tocilizumab and rituximab significantly reduced relapse risk in patients with AQP4-IgG+ NMOSD (P <.001). ARR was also significantly lower with either biologic treatment (P ≤0.01), along with improvements in EDSS scores (P <.001). Direct comparison between tocilizumab and rituximab showed no significant difference in relapse reduction, but AEs occurred less frequently in the tocilizumab group (21.4%) compared with the rituximab group (40.7%).

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Larger randomized-controlled trials are warranted to compare the efficacy and safety between IL-6R inhibitors and B cell-depleting agents in NMOSD and MOGAD.

In patients with MOGAD, tocilizumab was associated with significant reductions in ARR (P =.008) and greater improvements in EDSS scores compared to both prednisolone (P =.001) and rituximab (P =.03). However, relapse rates and ARR did not significantly differ between rituximab and prednisolone in this subgroup. AE rates were comparable between tocilizumab and rituximab in patients with MOGAD.

“Larger randomized-controlled trials are warranted to compare the efficacy and safety between IL-6R inhibitors and B cell-depleting agents in NMOSD and MOGAD,” the researchers concluded.

References:

Zhu L, Shi Y, Li Y, Xu X, Zhang C. A real-world comparative study on the efficacy and safety of tocilizumab and rituximab in patients with neuromyelitis optica spectrum disease and myelin oligodendrocyte glycoprotein antibody-associated disease. Abstract presented at: ACTRIMS Forum 2025; February 27-March 1; West Palm Beach, FL. V421.