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Neuropediatrics 2019; 50(03): 193-196
DOI: 10.1055/s-0039-1684004
Short Communication
Georg Thieme Verlag KG Stuttgart · New York

Two Cases of Pediatric AQP4-Antibody Positive Neuromyelitis Optica Spectrum Disorder Successfully Treated with Tocilizumab

Markus Breu
1   Department of Pediatric and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
,
Sarah Glatter
1   Department of Pediatric and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
,
Romana Höftberger
2   Institute of Neurology, Medical University of Vienna, Vienna, Austria
,
Michael Freilinger
1   Department of Pediatric and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
,
Karl Kircher
3   Department of Ophthalmology and Optometrics, Medical University of Vienna, Vienna, Austria
,
Gregor Kasprian
4   Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
,
Rainer Seidl
1   Department of Pediatric and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
,
Barbara Kornek
5   Department of Neurology, Medical University of Vienna, Vienna, Austria
› Author Affiliations Study Funding This study was supported in part by the grant “Jubiläumsfonds der Österreichischen Nationalbank, Project 16919” to R.H.
Further Information

Publication History

11 September 2018

04 February 2019

Publication Date:
26 March 2019 (online)

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Abstract

B cell depletion with the anti-CD20-antibody rituximab is widely considered treatment of choice for long-term immunotherapy in aquaporin-4 (AQP4)-antibody positive neuromyelitis optica spectrum disorder (NMOSD). However, up to 30% of patients suffer from relapses despite complete B cell depletion. In these cases, the IL6 (interleukin-6)-receptor blocking antibody tocilizumab has been suggested as an alternative. We report two female adolescents with AQP4-antibody positive NMOSD who relapsed under rituximab treatment and clinically stabilized after switching to monthly administrations of tocilizumab. Our data suggest that early escalation of therapy with tocilizumab may lead to stabilization of disease activity in pediatric NMOSD patients who relapse under B cell depletion.

Keywords

neuromyelitis optica - tocilizumab - pediatric - AQP4 - interleukin-6 - plasmablasts

Patient Consent

Written informed consent for patient information and MR images to be published was provided by the patients. The study was approved by the institutional review board (Ethikkomission der Medizinischen Universität Wien, No. EK1123_2015).


 

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