Abstract:

To preliminarily explore the feasibility and effectiveness of olfatomuzumab (OFA) in the treatment of patients with refractory neuromyelitis optica spectrum disorder (NMOSD). A 15-year-old adolescent female with seropositive AQP4-IgG and multiple relapses of refractory neuromyelitis optica spectrum disorder was given intravenous methylprednisolone, immunoglobulin, rituximab (RTX), and oral prednisone and mycophenolate mofetil for 5 years. She started to receive 4 doses of OFA (20 mg, subcutaneous injection) at intervals 9 months ago. The patient was observed for NMOSD recurrence, serum AQP4-IgG antibody titer, peripheral blood B cell level, and changes in cranial and spinal cord MRI during the 9-month period of OFA treatment. The patient's symptoms were stable without recurrence during the 9-month period of OFA treatment. The serum AQP4-IgG titer decreased, and the lesions in the cranial and spinal cord MRI decreased. There were no new lesions, and the tolerance was good without anaphylactic reactions or infectious adverse events. In addition to complete depletion of B cells, no lymphopenia or hypogammaglobulinemia was found. For patients with refractory NMOSD or other intolerant to immunotherapy, subcutaneous injection of OFA may be a safe and effective alternative treatment.

Key words: ofatumumab, AQP4-IgG, neuromyelitis optica spectrum disorders, refractory