Is long-term Rituximab use safe for a 33-year-old with NMOSD?

Question

Hi doctor,

I am a 33-year-old female. I was diagnosed with NMOSD after a sudden vision loss in one eye and leg weakness. I tested positive for AQP4 antibodies. It all started after I had COVID. I am terrified of another relapse.

What makes NMOSD worse in women?
Are treatments like Rituximab safe for long-term use?
Can this be confused with MS in women?

Thank you.

Answer 1

Hi,

Welcome to icliniq.com.

I read your query and understand your concerns.

NMOSD (neuromyelitis optica spectrum disorder), especially with anti-aquaporin-4 (AQP4) antibodies, is more common and often more severe in women.

Hormonal factors and immune system differences play a role in why it affects women more, and symptoms can worsen around pregnancy or hormonal shifts. Your experience of onset after COVID-19 is not uncommon because viral infections can sometimes trigger or unmask autoimmune diseases like NMOSD.

It is understandable to be afraid of a relapse, but early and consistent treatment is key. Rituximab is widely used as a first-line long-term therapy for AQP4 and NMOSD and has a good safety profile in most patients. Rituximab works by targeting B cells that drive the immune attack. But long-term risks include infections and low immunoglobulin levels, but regular monitoring helps catch these early.

NMOSD is often misdiagnosed as multiple sclerosis (MS), especially in women, because early symptoms can overlap, such as optic neuritis or spinal cord involvement. But NMOSD typically has more severe attacks, longer spinal cord lesions, and responds differently to treatment. And MS treatments like Interferons or Fingolimod can actually make NMOSD worse, so accurate diagnosis is critical.

You are doing the right thing by staying informed. The good news is that with the right treatment plan, many people with NMOSD live full lives and prevent further relapses.

I hope this helps.

Kindly follow up if you have more doubts.