Download fulltext HTML
1.
Maleki A, Colombo A, Look-Why S, Chang P, Anesi S, Foster CS. Rituximab Monotherapy versus Rituximab and Bortezomib Combination Therapy for Treatment of Non-paraneoplastic Autoimmune Retinopathy. JOVR [Internet]. 2022Nov.24 [cited 2024Jul.17];17(4):515–528. Available from: https://knepublishing.com/index.php/JOVR/article/view/12304

https://doi.org/10.18502/jovr.v17i4.12304

statistics

  • 500 Abstract Views
  • 331 PDF Views
  • 0 HTML Views

authors

  • Arash Maleki

    Arash Maleki

    Massachusetts Eye Research and Surgery Institution, Waltham, MA, USA
  • Amanda Colombo

    Amanda Colombo

    Massachusetts Eye Research and Surgery Institution, Waltham, MA, USA
  • Sydney Look-Why

    Sydney Look-Why

    Massachusetts Eye Research and Surgery Institution, Waltham, MA, USA
  • Peter Chang

    Peter Chang

    Massachusetts Eye Research and Surgery Institution, Waltham, MA, USA
  • Stephen Anesi

    Stephen Anesi

    Massachusetts Eye Research and Surgery Institution, Waltham, MA, USA
  • C. Stephen Foster

    C. Stephen Foster

    Massachusetts Eye Research and Surgery Institution, Waltham, MA, USA

Published Date

  • Nov 24, 2022
This journal is publishing all the articles under Creative Commons Attribution License CC BY 4.0.

Rituximab Monotherapy versus Rituximab and Bortezomib Combination Therapy for Treatment of Non-paraneoplastic Autoimmune Retinopathy

Journal of Ophthalmic and Vision Research (JOVR) / Oct–Dec 2022, Volume 17, Issue 4 / Pages 515–528

Abstract

Purpose: To study whether rituximab and bortezomib combination therapy is more effective than rituximab monotherapy in the treatment of nonparaneoplastic autoimmune retinopathy (npAIR).


Methods: Retrospective case series involving six patients with npAIR, taking either rituximab and bortezomib combination therapy (three cases) or rituximab monotherapy (one case and two historical patients).


Results: Patients on both treatment regimens showed stability in most of the visual function parameters during the one year of follow-up. Combination therapy resulted in improvement of scotopic combined rod and cone a-wave and b-wave amplitudes in all eyes where they were available (four eyes); however, rituximab monotherapy resulted in only two eyes with stable scotopic combined rod and cone a-wave and b-wave amplitudes, while four eyes showed a decrease in both a- and b-wave amplitudes. The average improvement in b-wave amplitude (50.7% ± 29.4% [range 25–90%]) was higher than the average improvement in awave amplitude (35.7% ± 9.74 [range 25–63%]). No severe adverse effects were reported.


Conclusion: Rituximab and bortezomib combination therapy may not be more effective than rituximab monotherapy in npAIR patients for most of the visual function parameters; however, this combination therapy may be more effective in improving scotopic combined rod and cone a- and b-wave amplitudes. This may indicate the higher efficacy of combination therapy when there is involvement of the inner retina.

Keywords:

Autoimmune Retinopathy, Bortezomib, Electroretinography, Nonparaneoplastic AIR, Rituximab, Visual Field

References
1. Mizener JB, Kimura AE, Adamus G, Thirkill CE, Goeken JA, Kardon RH. Autoimmune retinopathy in the absence of cancer. Am J Ophthalmol 1997;123:607–618.

2. Takiuti JT, Takahashi VK, Xu CL, Jauregui R, Tsang SH. Non-paraneoplastic related retinopathy: Clinical challenges and review. Ophthalmic Genet 2019;40:293–297.

3. Grange L, Dalal M, Nussenblatt RB, Sen HN. Autoimmune retinopathy. Am J Ophthalmol 2014;157:266–272.e1.

4. Sobrin L. Progress toward precisely diagnosing autoimmune retinopathy. Am J Ophthalmol 2018;188:xiv– xv.

5. Boudreault K, Justus S, Sengillo JD, Schuerch K, Lee W, Cabral T, et al. Efficacy of rituximab in non-paraneoplastic autoimmune retinopathy. Orphanet J Rare Dis 2017;12:129.

6. Fox AR, Gordon LK, Heckenlively JR, Davis JL, Goldstein DA, Lowder CY, et al. Consensus on the diagnosis and management of nonparaneoplastic autoimmune retinopathy using a modified delphi approach. Am J Ophthalmol 2016;168:183–190.

7. Maleki A, Lamba N, Ma L, Lee S, Schmidt A, Foster CS. Rituximab as a monotherapy or in combination therapy for the treatment of non-paraneoplastic autoimmune retinopathy. Clin Opthalmol 2017;11:377–385.

8. Fox A, Jeffrey B, Hasni S, Nussenblatt R, Sen HN. Rituximab treatment for nonparaneoplastic autoimmune retinopathy. Can J Ophthalmol 2015;50:e101–104.

9. Davoudi S, Ebrahimiadib N, Yasa C, Sevgi DD, Roohipoor R, Papavasilieou E, et al. Outcomes in autoimmune retinopathy patients treated with Rituximab. Am J Ophthalmol 2017;180:124–132.

10. Uludag G, Onal S, Arf S, Sayman Muslubas I, Selcukbiricik F, Koc Akbay A, et al. Electroretinographic improvement after rituximab therapy in a patient with autoimmune retinopathy. Am J Ophthalmol Case Rep 2016;2:4–7.

11. Armbrust KR, Fox AR, Jeffrey BG, Sherry P, Sen HN. Rituximab for autoimmune retinopathy: Results of a Phase I/II clinical trial. Taiwan J Ophthalmol 2020;11:64–70.

12. Russo A, Fratto ME, Bazan V, Schiró V, Agnese V, Cicero G, et al. Targeting apoptosis in solid tumors: The role of bortezomib from preclinical to clinical evidence. Expert Opin Ther Targets 2007;11:1571–1586.

13. Benson MD, Plemel DJ, Yacyshyn E, Sandhu I, MacDonald IM, Baker CF. Combination treatment with Rituximab and Bortezomib in a patient with non-paraneoplastic autoimmune retinopathy. Ocul Immunol Inflamm 2020;28:958–965.

14. Adamus G, Ren G, Weleber RG. Autoantibodies against retinal proteins in paraneoplastic and autoimmune retinopathy. BMC Ophthalmol 2004;4:5.

15. McCulloch DL, Marmor MF, Brigell MG, Hamilton R, Holder GE, Tzekov R, et al. ISCEV Standard for fullfield clinical electroretinography (2015 update). Doc Ophthalmol 2015;130:1–12.

16. Cao JH, Oray M, Cocho L, Foster CS. Rituximab in the treatment of refractory noninfectious scleritis. Am J Ophthalmol 2016;164:22–28.

17. Mohan M, Matin A, Davies FE. Update on the optimal use of bortezomib in the treatment of multiple myeloma. Cancer Manag Res 2017;9:51–63.

18. Fishman GA, Chappelow AV, Anderson RJ, Rotenstreich Y, Derlacki DJ. Short-term inter-visit variability of erg amplitudes in normal subjects and patients with retinitis pigmentosa. Retina 2005;25:1014–1021.

19. Mills RP, Budenz DL, Lee PP, Noecker RJ, Walt JG, Siegartel LR, et al. Categorizing the stage of glaucoma from pre-diagnosis to end-stage disease. Am J Ophthalmol 2006;141:24–30.

20. Simon R. Optimal two-stage designs for phase II clinical trials. Control Clin Trials 1989;10:1–10.

21. Khanna S, Martins A, Oakey Z, Mititelu M. Nonparaneoplastic autoimmune retinopathy: Multimodal testing characteristics of 13 cases. J Ophthalmic Inflamm Infect 2019;9:6.

22. Adamus G. Are Anti-Retinal Autoantibodies a cause or a consequence of retinal degeneration in autoimmune retinopathies? Front Immunol 2018;9:765.

23. Garcia CM, Maleki A, Look-Why S, Manhapra A, Durrani K, Foster CS. Non-paraneoplastic autoimmune retinopathy versus Pericentral Retinal Degeneration phenotype: Which came first? A case report. Retin Cases Brief Rep 2021. Publish Ahead of Print: https://doi.org/10.1097/ICB.0000000000001199