The role of the intensivist in the management of pulmonary-renal syndrome includes appropriate respiratory support and recognition and management of concurrent infection, hypovolemia, acute anemia, and coagulopathy.
Based on an observational prospective study of 16 patients with anti-myelin oligodendrocyte protein (MOG) disease and 29 anti-aquaporin-4 disease, the authors report lesser efficacy of rituximab in anti-MOG patients, characterized by higher occurrence of relapses in the anti-MOG group, even while the biological effect of rituximab on memory B-cell suppression was sustained.
Rituximab has been used “off label” for the treatment of primary chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) with variable reports of success. These authors reported a high rate of response in patients who developed CIDP in the setting of other systemic immune-mediated disorders.
Anti-MAG antibody-associated neuropathy may present as many disorders, including small fiber neuropathy, sensorimotor neuropathy, Guillain-Barré-like syndrome, and multifocal motor neuropathy. Rituximab appears to be the best therapeutic option.
Based on a meta-analysis and review of rituximab use in the treatment of neuromyelitis optica spectrum disorders, the authors reported that rituximab was efficacious in reducing relapse rate and disability, but cautioned about potential side effects and adverse events, especially when considering rituximab as first-line therapy.