Nomogram for the prediction of relapse factors in patients with neuromyelitis optica spectrum disorder during rituximab treatment

Develop a nomogram to analyse the factors influencing the relapse of neuromyelitis optica spectrum disorder (NMOSD) during rituximab (RTX) treatment.

A retrospective analysis of 214 NMOSD patients identified 181 with AQP4-IgG-seropositive. 32 patients who relapsed during RTX treatment were included, and 122 sets of lymphocyte subset monitoring data were collected. 110 sets of data were finally included and divided into relapse (n = 30) and nonrelapse (n = 80) groups depending on whether a relapse occurred between two adjacent RTX treatments. Logistic and LASSO regressions were used to identify the relevant factors influencing NMOSD relapse, and a nomogram was constructed. Receiver operating characteristic (ROC) curves were generated to evaluate the nomogram’s ability to differentiate, and the bootstrap method was utilized for internal validation. Calibration curve and decision curve analysis were also conducted.

Comparing baseline data revealed differences in the RTX administration interval, CD3⁻CD19⁺ B lymphocyte and CD3⁻CD56⁺ NK cell levels. The RTX administration interval and the level of CD3⁻CD19⁺ B lymphocytes were independent variables influencing relapse. The nomogram had an area under the curve (AUC) of 0.71 and a 95% confidence interval (CI) of 0.58–0.83. The Hosmer-Lemeshow (H-L) goodness-of-fit test yielded a χ² = 11.80 (p = 0.16). Decision curve analysis revealed that the model provided greater net benefits within the threshold probability range of 0.18–0.98.

The nomogram developed in this study showed that the RTX administration interval and CD3⁻CD19⁺ B lymphocyte levels independently influence NMOSD relapse, indicating good discriminative ability, consistency, and clinical benefits.