Anti-rabies monoclonal antibody(MassBiologics)

Given the growing popularity of Rituximab (Rmab) treatment as a potential substitute for cyclophosphamide, we conducted this review to determine aspects related to Rmab therapy in central nervous system vasculitis (CNSV) patients, aiming to establish both the beneficial and detrimental consequences of Rmab while providing clinical guidance for managing patients' conditions. This systematic review was prepared following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The PubMed, Web of Science, and Scopus databases were utilized to investigate Rmab treatment in CNSV from January 2015 to May 2024. The research question was structured using the Population, Intervention, Comparison, Outcome, and Study Design (PICOS) criteria. Case series with only three or more unique cases, prospective or retrospective non-randomized studies, and randomized controlled trials (RCTs) were addressed. The initial evaluations were performed in PubMed, Scopus, and Web of Science. After removing duplicate entries, 177 publications were obtained, and 41 were chosen for full-text assessment. The review then incorporated information gathered from 27 studies, including 4 case series, 15 non-randomized cohorts, and 8 RCTs. Rmab is generally regarded as effective for CNSV therapy. Given its success, induction Rmab therapy is now frequently employed as maintenance therapy for CNSV patients. Rmab is a viable option for the induction of remission and maintenance treatment, with a successful reduction in relapse rates.

Denosumab (Dmab) is widely used for the treatment of post-menopausal osteoporosis. Its discontinuation is sometimes accompanied by multiple vertebral fractures. Romosozumab (Rmab) has not been tested for its ability to prevent the rebound phenomenon.

We present the case of a 68-year-old female patient with post-menopausal osteoporosis under treatment with Rmab who presented with multiple vertebral fractures after denosumab discontinuation. The addition of Rmab did not prevent new-onset rebound-associated vertebral fractures. The patient discontinued Rmab and Dmab was re-initiated. After six months, no new vertebral fractures occurred, bone mineral density increased and bone turnover markers remained suppressed.

Our clinical case illustrates the ineffectiveness of Rmab to prevent the multiple vertebral fracture cascade attributable to discontinuation of Dmab. We believe that treatment with Rmab might not be enough to prevent this phenomenon. Treatment with Dmab or possibly combination treatment with Dmab and Rmab could be another treatment option.