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To the Editor We read with interest the article by Damato et al.1 This systematic review and meta-analysis confirmed the efficacy of rituximab treatment in reducing episode frequency and in stabilizing neurological disabilities in neuromyelitis optica spectrum disorders (NMOSDs). However, the authors proposed caution in prescribing rituximab as a first-line therapy owing to its safety profile. We do not find this conclusion to be warranted as they did not show any evidence of increased safety concerns for rituximab when used as a first-line therapy, nor did they show an inferior safety profile for rituximab compared with that of other immunosuppressive agents.
Kim S, Kim HJ. Rituximab in Neuromyelitis Optica Spectrum Disorders: Why Not as First-Line Therapy. JAMA Neurol. 2017;74(4):482. doi:10.1001/jamaneurol.2016.5933
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